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

Background: 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. Methods: The study population comprised 292 consecutive patients (aged 64.6 ± 8.1 years) 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 13.8 years. Result: 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 10 min 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 1 mmol/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 10 mg/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). Conclusions: In this study, we showed that reduced fibrin clot susceptibility to fibrinolysis is weekly associated with long‐term mortality in advanced CAD. [ABSTRACT FROM AUTHOR]