Postoperative activity, but not preoperative activity, of antithrombin is associated with major adverse cardiac events after coronary artery bypass graft surgery

Sean Garvin, Jochen D. Muehlschlegel, Tjörvi E. Perry, Junliang Chen, Kuang Yu Liu, Amanda A. Fox, Charles D. Collard, Sary F. Aranki, Stanton K. Shernan, Simon C. Body

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

BACKGROUND: Low levels of antithrombin (AT) have been independently associated with prolonged intensive care unit stay and an increased incidence of neurologic and thromboembolic events after cardiac surgery. We hypothesized that perioperative AT activity is independently associated with postoperative major adverse cardiac events (MACEs) in patients undergoing coronary artery bypass graft (CABG) surgery. METHODS: We prospectively studied 1403 patients undergoing primary CABG surgery with cardiopulmonary bypass (CPB) (http://clinicaltrials.gov/show/NCT00281164). The primary clinical end point was occurrence of MACE, defined as a composite outcome of any one or more of the following: postoperative death, reoperation for coronary graft occlusion, myocardial infarction, stroke, pulmonary embolism, or cardiac arrest until first hospital discharge. Plasma AT activity was measured before surgery, after post-CPB protamine, and on postoperative days (PODs) 1-5. Multivariate logistic regression modeling was performed to estimate the independent effect of perioperative AT activity upon MACE. RESULTS: MACE occurred in 146 patients (10.4%), consisting of postoperative mortality (n = 12), myocardial infarction (n = 108), stroke (n = 17), pulmonary embolism (n = 8), cardiac arrest (n = 16), or a subsequent postoperative or catheter-based treatment for graft occlusion (n = 6). AT activity at baseline did not differ between patients with (0.91 ± 0.13 IU/mL; n = 146) and without (0.92 ± 0.13 IU/mL; n = 1257) (P = 0.18) MACE. AT activity in both groups was markedly reduced immediately after CPB and recovered to baseline values over the ensuing 5 PODs. Postoperative AT activity was significantly lower in patients with MACE than those without MACE. After adjustment for clinical predictors of MACE, AT activity on PODs 2 and 3 was associated with MACE. CONCLUSIONS: Preoperative AT activity is not associated with MACE after CABG surgery. MACE is independently associated with postoperative AT activity but only at time points occurring predominantly after the MACE.

Original languageEnglish (US)
Pages (from-to)862-869
Number of pages8
JournalAnesthesia and Analgesia
Volume111
Issue number4
DOIs
StatePublished - Oct 2010

Fingerprint

Antithrombins
Coronary Artery Bypass
Transplants
Cardiopulmonary Bypass
Heart Arrest
Pulmonary Embolism
Stroke
Myocardial Infarction
Protamines
Coronary Occlusion
Reoperation
Nervous System
Thoracic Surgery
Intensive Care Units
Catheters
Logistic Models

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Postoperative activity, but not preoperative activity, of antithrombin is associated with major adverse cardiac events after coronary artery bypass graft surgery. / Garvin, Sean; Muehlschlegel, Jochen D.; Perry, Tjörvi E.; Chen, Junliang; Liu, Kuang Yu; Fox, Amanda A.; Collard, Charles D.; Aranki, Sary F.; Shernan, Stanton K.; Body, Simon C.

In: Anesthesia and Analgesia, Vol. 111, No. 4, 10.2010, p. 862-869.

Research output: Contribution to journalArticle

Garvin, Sean ; Muehlschlegel, Jochen D. ; Perry, Tjörvi E. ; Chen, Junliang ; Liu, Kuang Yu ; Fox, Amanda A. ; Collard, Charles D. ; Aranki, Sary F. ; Shernan, Stanton K. ; Body, Simon C. / Postoperative activity, but not preoperative activity, of antithrombin is associated with major adverse cardiac events after coronary artery bypass graft surgery. In: Anesthesia and Analgesia. 2010 ; Vol. 111, No. 4. pp. 862-869.
@article{b5ab35b5e5944dbb85235e5b3a143e17,
title = "Postoperative activity, but not preoperative activity, of antithrombin is associated with major adverse cardiac events after coronary artery bypass graft surgery",
abstract = "BACKGROUND: Low levels of antithrombin (AT) have been independently associated with prolonged intensive care unit stay and an increased incidence of neurologic and thromboembolic events after cardiac surgery. We hypothesized that perioperative AT activity is independently associated with postoperative major adverse cardiac events (MACEs) in patients undergoing coronary artery bypass graft (CABG) surgery. METHODS: We prospectively studied 1403 patients undergoing primary CABG surgery with cardiopulmonary bypass (CPB) (http://clinicaltrials.gov/show/NCT00281164). The primary clinical end point was occurrence of MACE, defined as a composite outcome of any one or more of the following: postoperative death, reoperation for coronary graft occlusion, myocardial infarction, stroke, pulmonary embolism, or cardiac arrest until first hospital discharge. Plasma AT activity was measured before surgery, after post-CPB protamine, and on postoperative days (PODs) 1-5. Multivariate logistic regression modeling was performed to estimate the independent effect of perioperative AT activity upon MACE. RESULTS: MACE occurred in 146 patients (10.4{\%}), consisting of postoperative mortality (n = 12), myocardial infarction (n = 108), stroke (n = 17), pulmonary embolism (n = 8), cardiac arrest (n = 16), or a subsequent postoperative or catheter-based treatment for graft occlusion (n = 6). AT activity at baseline did not differ between patients with (0.91 ± 0.13 IU/mL; n = 146) and without (0.92 ± 0.13 IU/mL; n = 1257) (P = 0.18) MACE. AT activity in both groups was markedly reduced immediately after CPB and recovered to baseline values over the ensuing 5 PODs. Postoperative AT activity was significantly lower in patients with MACE than those without MACE. After adjustment for clinical predictors of MACE, AT activity on PODs 2 and 3 was associated with MACE. CONCLUSIONS: Preoperative AT activity is not associated with MACE after CABG surgery. MACE is independently associated with postoperative AT activity but only at time points occurring predominantly after the MACE.",
author = "Sean Garvin and Muehlschlegel, {Jochen D.} and Perry, {Tj{\"o}rvi E.} and Junliang Chen and Liu, {Kuang Yu} and Fox, {Amanda A.} and Collard, {Charles D.} and Aranki, {Sary F.} and Shernan, {Stanton K.} and Body, {Simon C.}",
year = "2010",
month = "10",
doi = "10.1213/ANE.0b013e3181b7908c",
language = "English (US)",
volume = "111",
pages = "862--869",
journal = "Anesthesia and Analgesia",
issn = "0003-2999",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Postoperative activity, but not preoperative activity, of antithrombin is associated with major adverse cardiac events after coronary artery bypass graft surgery

AU - Garvin, Sean

AU - Muehlschlegel, Jochen D.

AU - Perry, Tjörvi E.

AU - Chen, Junliang

AU - Liu, Kuang Yu

AU - Fox, Amanda A.

AU - Collard, Charles D.

AU - Aranki, Sary F.

AU - Shernan, Stanton K.

AU - Body, Simon C.

PY - 2010/10

Y1 - 2010/10

N2 - BACKGROUND: Low levels of antithrombin (AT) have been independently associated with prolonged intensive care unit stay and an increased incidence of neurologic and thromboembolic events after cardiac surgery. We hypothesized that perioperative AT activity is independently associated with postoperative major adverse cardiac events (MACEs) in patients undergoing coronary artery bypass graft (CABG) surgery. METHODS: We prospectively studied 1403 patients undergoing primary CABG surgery with cardiopulmonary bypass (CPB) (http://clinicaltrials.gov/show/NCT00281164). The primary clinical end point was occurrence of MACE, defined as a composite outcome of any one or more of the following: postoperative death, reoperation for coronary graft occlusion, myocardial infarction, stroke, pulmonary embolism, or cardiac arrest until first hospital discharge. Plasma AT activity was measured before surgery, after post-CPB protamine, and on postoperative days (PODs) 1-5. Multivariate logistic regression modeling was performed to estimate the independent effect of perioperative AT activity upon MACE. RESULTS: MACE occurred in 146 patients (10.4%), consisting of postoperative mortality (n = 12), myocardial infarction (n = 108), stroke (n = 17), pulmonary embolism (n = 8), cardiac arrest (n = 16), or a subsequent postoperative or catheter-based treatment for graft occlusion (n = 6). AT activity at baseline did not differ between patients with (0.91 ± 0.13 IU/mL; n = 146) and without (0.92 ± 0.13 IU/mL; n = 1257) (P = 0.18) MACE. AT activity in both groups was markedly reduced immediately after CPB and recovered to baseline values over the ensuing 5 PODs. Postoperative AT activity was significantly lower in patients with MACE than those without MACE. After adjustment for clinical predictors of MACE, AT activity on PODs 2 and 3 was associated with MACE. CONCLUSIONS: Preoperative AT activity is not associated with MACE after CABG surgery. MACE is independently associated with postoperative AT activity but only at time points occurring predominantly after the MACE.

AB - BACKGROUND: Low levels of antithrombin (AT) have been independently associated with prolonged intensive care unit stay and an increased incidence of neurologic and thromboembolic events after cardiac surgery. We hypothesized that perioperative AT activity is independently associated with postoperative major adverse cardiac events (MACEs) in patients undergoing coronary artery bypass graft (CABG) surgery. METHODS: We prospectively studied 1403 patients undergoing primary CABG surgery with cardiopulmonary bypass (CPB) (http://clinicaltrials.gov/show/NCT00281164). The primary clinical end point was occurrence of MACE, defined as a composite outcome of any one or more of the following: postoperative death, reoperation for coronary graft occlusion, myocardial infarction, stroke, pulmonary embolism, or cardiac arrest until first hospital discharge. Plasma AT activity was measured before surgery, after post-CPB protamine, and on postoperative days (PODs) 1-5. Multivariate logistic regression modeling was performed to estimate the independent effect of perioperative AT activity upon MACE. RESULTS: MACE occurred in 146 patients (10.4%), consisting of postoperative mortality (n = 12), myocardial infarction (n = 108), stroke (n = 17), pulmonary embolism (n = 8), cardiac arrest (n = 16), or a subsequent postoperative or catheter-based treatment for graft occlusion (n = 6). AT activity at baseline did not differ between patients with (0.91 ± 0.13 IU/mL; n = 146) and without (0.92 ± 0.13 IU/mL; n = 1257) (P = 0.18) MACE. AT activity in both groups was markedly reduced immediately after CPB and recovered to baseline values over the ensuing 5 PODs. Postoperative AT activity was significantly lower in patients with MACE than those without MACE. After adjustment for clinical predictors of MACE, AT activity on PODs 2 and 3 was associated with MACE. CONCLUSIONS: Preoperative AT activity is not associated with MACE after CABG surgery. MACE is independently associated with postoperative AT activity but only at time points occurring predominantly after the MACE.

UR - http://www.scopus.com/inward/record.url?scp=77957709517&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77957709517&partnerID=8YFLogxK

U2 - 10.1213/ANE.0b013e3181b7908c

DO - 10.1213/ANE.0b013e3181b7908c

M3 - Article

C2 - 19820236

AN - SCOPUS:77957709517

VL - 111

SP - 862

EP - 869

JO - Anesthesia and Analgesia

JF - Anesthesia and Analgesia

SN - 0003-2999

IS - 4

ER -