Impaired fibrin clot lysis is associated with increased mortality in patients after coronary artery bypass grafting: A long‐term follow‐up study

Abstract

Mortality after coronary artery bypass grafting (CABG) is primarily thromboembolic by nature. We investigated whether impaired fibrinolysis observed in cardiovascular diseases is associated with long-term mortality following CABG. The study population comprised 292 consecutive patients (aged 64.6±8.1years) who underwent scheduled CABG. We measured plasma clot lysis time (CLT) preoperatively as a measure of fibrinolysis capacity. Cardiovascular and all-cause deaths were recorded during a median follow-up of 13.8years. CLT positively correlated with age (r=.56, p<.001), fibrinogen (r=.25, p=.002) and EuroSCORE I (r=.32, p<.001). The cardiovascular and overall mortality rates were 3.0 and 4.9 per 100 patient-years (32.4% vs 52.8%) respectively. In patients who died from cardiovascular and all causes, CLT was prolonged compared with survivors (both p<.050). Multivariable Cox regression analysis adjusted for potential confounders showed that long-term cardiovascular and all-cause deaths were associated with CLT (HR per 10min 1.206; 95% CI 1.037-1.402, p=.015 and HR 1.164; 96% CI 1.032-1.309, p=.012), low-density lipoprotein cholesterol (HR per 1mmol/L 1.556; 95% CI 1.205-2.010, p<.001 and HR 1.388; 96% CI 1.125-1.703, p=.002), C-reactive protein (HR per 10mg/L 1.171; 95% CI 1.046-1.312, p=.006 and HR 1.127; 95% CI 1.005-1.237, p=.022) and EuroSCORE I (HR 1.173; 95% CI 1.016-1.355, p=.030 and HR 1.183; 95% CI 1.059-1.317, p=.003 respectively). Type 2 diabetes was solely associated with overall mortality (HR 1.594; 96% CI 1.088-2.334, p=.017). In this study, we showed that reduced fibrin clot susceptibility to fibrinolysis is weekly associated with long-term mortality in advanced CAD.