Open AccessDifferential Impact of Serial Measurement of Nonplatelet Thromboxane Generation on Long‐Term Outcome After Cardiac Surgery
Author(s) -
Kakouros Nikolaos,
Gluckman Tyler J.,
Conte John V.,
Kickler Thomas S.,
Laws Katherine,
Barton Bruce A.,
Rade Jeffrey J.
Publication year - 2017
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.117.007486
Subject(s) - medicine , hazard ratio , cardiology , myocardial infarction , aspirin , coronary artery bypass surgery , thromboxane , stroke (engine) , cardiopulmonary bypass , surgery , coronary artery disease , thromboxane a2 , creatinine , thromboxane b2 , artery , platelet , confidence interval , mechanical engineering , engineering
Background Systemic thromboxane generation, not suppressible by standard aspirin therapy and likely arising from nonplatelet sources, increases the risk of atherothrombosis and death in patients with cardiovascular disease. In the RIGOR (Reduction in Graft Occlusion Rates) study, greater nonplatelet thromboxane generation occurred early compared with late after coronary artery bypass graft surgery, although only the latter correlated with graft failure. We hypothesize that a similar differential association exists between nonplatelet thromboxane generation and long‐term clinical outcome. Methods and Results Five‐year outcome data were analyzed for 290 RIGOR subjects taking aspirin with suppressed platelet thromboxane generation. Multivariable modeling was performed to define the relative predictive value of the urine thromboxane metabolite, 11‐dehydrothromboxane B 2 (11‐dhTXB 2 ), measured 3 days versus 6 months after surgery on the composite end point of death, myocardial infarction, revascularization or stroke, and death alone. 11‐dhTXB 2 measured 3 days after surgery did not independently predict outcome, whereas 11‐dhTXB 2 >450 pg/mg creatinine measured 6 months after surgery predicted the composite end point (adjusted hazard ratio, 1.79; P =0.02) and death (adjusted hazard ratio, 2.90; P =0.01) at 5 years compared with lower values. Additional modeling revealed 11‐dhTXB 2 measured early after surgery associated with several markers of inflammation, in contrast to 11‐dhTXB 2 measured 6 months later, which highly associated with oxidative stress. Conclusions Long‐term nonplatelet thromboxane generation after coronary artery bypass graft surgery is a novel risk factor for 5‐year adverse outcome, including death. In contrast, nonplatelet thromboxane generation in the early postoperative period appears to be driven predominantly by inflammation and did not independently predict long‐term clinical outcome.