AUTHOR=Gao Mingxin , Wen Wanwan , Gu Chengxiong , Zhang XiaoLi , Yu Yang , Li Haiyang 

TITLE=Coronary plaque burden predicts perioperative cardiovascular events after coronary endarterectomy

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1175287

DOI=10.3389/fcvm.2023.1175287

ISSN=2297-055X

ABSTRACT=Background and Aims: The risk factors of perioperative and long-term cardiovascular events in patients undergoing coronary artery bypass grafting (CABG) with adjunctive coronary endarterectomy (CE) are not well determined. This study evaluated the clinical value of coronary plaque burden, coronary anatomic stenosis, and serum biomarkers for predicting perioperative and long-term cardiovascular events after off-pump CABG+CE.
Methods: This retrospective cohort single-center study enrolled 125 patients undergoing off-pump CABG+CE between February 2018 and September 2021 in China. Coronary plaque burden was reflected by the length of plaque removed by CE. Plaque length-max, which represents the plaque length in patients undergoing single-vessel CE and the maximum plaque length in patients undergoing multivessel CE was calculated. The primary endpoint was postoperative myocardial infraction (PMI). The secondary endpoint was major adverse cardiac or cerebrovascular events and graft occlusion.
Results: Plaque length-max was significantly higher in patients with PMI than in those without PMI (2.4±1.5 vs. 1.6±0.9, p=.001). A threshold plaque length-max of 1.15 cm was an independent predictor of PMI (area under the curve: 0.67; sensitivity 87.9%; specificity 59.8%; p=.005). Patients with plaque length-max≥1.15 had a >5-fold increase in PMI after adjusting for confounding factors (odds ratio=5.89; p=.002). Furthermore, interleukin-6 (Beta:.32: p=.028), CD68 (Beta=.34; p=.045), and osteopontin (Beta=.43; p=.008) were significantly correlated with plaque length-max.
Conclusions: Plaque length-max was superior to clinical cardiovascular risk factors in predicting PMI occurrence after off-pump CABG+CE, which might be associated with systemic and plaque inflammation state.