Association between white blood cell count and coronary artery bypass graft failure: an individual patient data analysis of clinical trials
Abstract Background Baseline systemic inflammation is associated with worse long-term outcomes after coronary artery bypass grafting [CABG], but the mechanisms of this association are unclear. This study aims to explore the association between pre-operative white blood cell [WBC] count and CABG graf...
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| Format: | Article |
| Language: | English |
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BMC
2025-01-01
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| Series: | Journal of Cardiothoracic Surgery |
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| Online Access: | https://doi.org/10.1186/s13019-024-03330-5 |
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| author | Kevin R. An Sigrid Sandner Joyce Peper Yanzai Zhou Jurrien M. ten Berg Lamia Harik Yunpeng Zhu Laura M. Willemsen Qiang Zhao Björn Redfors Subodh Verma Mario F. L. Gaudino |
| author_facet | Kevin R. An Sigrid Sandner Joyce Peper Yanzai Zhou Jurrien M. ten Berg Lamia Harik Yunpeng Zhu Laura M. Willemsen Qiang Zhao Björn Redfors Subodh Verma Mario F. L. Gaudino |
| author_sort | Kevin R. An |
| collection | DOAJ |
| description | Abstract Background Baseline systemic inflammation is associated with worse long-term outcomes after coronary artery bypass grafting [CABG], but the mechanisms of this association are unclear. This study aims to explore the association between pre-operative white blood cell [WBC] count and CABG graft failure. Methods We pooled individual patient data from two randomized clinical trials with systematic CABG graft imaging. The primary analysis was the association between pre-operative WBC count and graft failure, as a continuous variable, at the time of imaging after CABG, using mixed-effects multivariable logistic regression models. Results Overall, 910 patients and 2,036 grafts were included in the analysis [1,120 saphenous vein grafts, 828 left internal thoracic arteries, 76 right internal thoracic arteries, and 12 radial arteries]. The median time to imaging was 1.01 [interquartile range (IQR), 0.99;1.03] years and the median pre-operative WBC count was 7.1 [IQR, 6.0;8.4] x 109/L. There was no association between WBC count and graft failure at both the patient and the individual graft level [adjusted odds ratio (aOR) 1.07 (95% confidence interval (CI), 0.98;1.17), p = 0.11 and aOR 1.09 (95% CI, 0.91;1.30), p = 0.37], respectively. When evaluated as a dichotomous variable [≥ 11 vs. < 11 × 109/L] and by quartile, WBC count was not associated with graft failure at the patient and individual graft levels. Conclusion In this pooled analysis of individual patient data from two randomized clinical trials, WBC count was not associated with graft failure after CABG. The reported association between inflammation and CABG is likely mediated through other mechanisms, such as native coronary artery disease progression. Impact on daily practice The lack of a clear association between WBC count and graft failure suggests that pre-operative WBC count should not be routinely used as a predictor of graft failure after CABG. |
| format | Article |
| id | doaj-art-70d65853b07245448eb133b7f9d3087d |
| institution | Kabale University |
| issn | 1749-8090 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj-art-70d65853b07245448eb133b7f9d3087d2025-01-26T12:52:01ZengBMCJournal of Cardiothoracic Surgery1749-80902025-01-012011810.1186/s13019-024-03330-5Association between white blood cell count and coronary artery bypass graft failure: an individual patient data analysis of clinical trialsKevin R. An0Sigrid Sandner1Joyce Peper2Yanzai Zhou3Jurrien M. ten Berg4Lamia Harik5Yunpeng Zhu6Laura M. Willemsen7Qiang Zhao8Björn Redfors9Subodh Verma10Mario F. L. Gaudino11Department of Cardiothoracic Surgery, Weill Cornell MedicineDepartment of Cardiac Surgery, Medical University of ViennaDepartment of Cardiology, St. Antonius HospitalDepartment of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong UniversityDepartment of Cardiology, St. Antonius HospitalDepartment of Cardiothoracic Surgery, Weill Cornell MedicineDepartment of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong UniversityDepartment of Cardiology, St. Antonius HospitalDepartment of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong UniversityDepartment of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg UniversityDivision of Cardiac Surgery, St. Michael’s Hospital, University of TorontoDepartment of Cardiothoracic Surgery, Weill Cornell MedicineAbstract Background Baseline systemic inflammation is associated with worse long-term outcomes after coronary artery bypass grafting [CABG], but the mechanisms of this association are unclear. This study aims to explore the association between pre-operative white blood cell [WBC] count and CABG graft failure. Methods We pooled individual patient data from two randomized clinical trials with systematic CABG graft imaging. The primary analysis was the association between pre-operative WBC count and graft failure, as a continuous variable, at the time of imaging after CABG, using mixed-effects multivariable logistic regression models. Results Overall, 910 patients and 2,036 grafts were included in the analysis [1,120 saphenous vein grafts, 828 left internal thoracic arteries, 76 right internal thoracic arteries, and 12 radial arteries]. The median time to imaging was 1.01 [interquartile range (IQR), 0.99;1.03] years and the median pre-operative WBC count was 7.1 [IQR, 6.0;8.4] x 109/L. There was no association between WBC count and graft failure at both the patient and the individual graft level [adjusted odds ratio (aOR) 1.07 (95% confidence interval (CI), 0.98;1.17), p = 0.11 and aOR 1.09 (95% CI, 0.91;1.30), p = 0.37], respectively. When evaluated as a dichotomous variable [≥ 11 vs. < 11 × 109/L] and by quartile, WBC count was not associated with graft failure at the patient and individual graft levels. Conclusion In this pooled analysis of individual patient data from two randomized clinical trials, WBC count was not associated with graft failure after CABG. The reported association between inflammation and CABG is likely mediated through other mechanisms, such as native coronary artery disease progression. Impact on daily practice The lack of a clear association between WBC count and graft failure suggests that pre-operative WBC count should not be routinely used as a predictor of graft failure after CABG.https://doi.org/10.1186/s13019-024-03330-5Leukocyte countLeukocytesSaphenous vein graftArterial graftCardiac surgeryPerioperative |
| spellingShingle | Kevin R. An Sigrid Sandner Joyce Peper Yanzai Zhou Jurrien M. ten Berg Lamia Harik Yunpeng Zhu Laura M. Willemsen Qiang Zhao Björn Redfors Subodh Verma Mario F. L. Gaudino Association between white blood cell count and coronary artery bypass graft failure: an individual patient data analysis of clinical trials Journal of Cardiothoracic Surgery Leukocyte count Leukocytes Saphenous vein graft Arterial graft Cardiac surgery Perioperative |
| title | Association between white blood cell count and coronary artery bypass graft failure: an individual patient data analysis of clinical trials |
| title_full | Association between white blood cell count and coronary artery bypass graft failure: an individual patient data analysis of clinical trials |
| title_fullStr | Association between white blood cell count and coronary artery bypass graft failure: an individual patient data analysis of clinical trials |
| title_full_unstemmed | Association between white blood cell count and coronary artery bypass graft failure: an individual patient data analysis of clinical trials |
| title_short | Association between white blood cell count and coronary artery bypass graft failure: an individual patient data analysis of clinical trials |
| title_sort | association between white blood cell count and coronary artery bypass graft failure an individual patient data analysis of clinical trials |
| topic | Leukocyte count Leukocytes Saphenous vein graft Arterial graft Cardiac surgery Perioperative |
| url | https://doi.org/10.1186/s13019-024-03330-5 |
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