Download PDF
Thromb Haemost 2003; 89(05): 885-891
DOI: 10.1055/s-0037-1613476
Vascular Development and Vessel Remodelling
Schattauer GmbH

Preoperative plasma fibrinogen levels predict mortality after coronary artery bypass grafting

Henry Völzke
1   Department of Epidemiology and Social Medicine
,
Daniel M. Robinson
2   Clinic of Internal Medicine B
,
Volker Kleine
2   Clinic of Internal Medicine B
,
Sabine Hertwig
2   Clinic of Internal Medicine B
,
Christian Schwahn
3   Department of Biostatistics and, Ernst Moritz Arndt University, Greifswald, Germany
,
Rita Grimm
4   Department of Physiology, Ernst Moritz Arndt University, Greifswald, Germany
,
Lothar Eckel
5   Heart Center Mecklenburg-Vorpommern, Karlsburg, Germany
,
Rainer Rettig
4   Department of Physiology, Ernst Moritz Arndt University, Greifswald, Germany
› Author Affiliations
Further Information

Publication History

Received 10 December 2002

Accepted after revision 26 February 2003

Publication Date:
09 December 2017 (online)

  PDF Download  Permissions and Reprints

Summary

This study was designed to investigate whether plasma fibrinogen levels as well as the β-fibrinogen –455 G/A genotype are associated with outcome after coronary artery bypass graft (CABG) operation.

We enrolled 249 consecutive CAD patients one day before they underwent a CABG operation. Data from 220 patients with available plasma fibrinogen levels were analyzed. The primary end-point was total mortality, the secondary end-point mortality from cardiac causes or the need for myocardial revascularization. The 2-year total mortality was 9.1% in the entire cohort. Multivariable analysis revealed an independent relationship between the primary end-point and preoperative plasma fibrinogen levels but not the β-fibrinogen –455 G/A geno-type. Neither preoperative plasma fibrinogen levels nor the β-fibrinogen –455 G/A genotype could predict the secondary end-point.

We conclude, that elevated preoperative plasma fibrinogen levels, but not the β-fibrinogen -455 G/A genotype predict the total mortality after CABG operation.

Keywords

Fibrinogen - β-fibrinogen-455 G/A gene polymorphism - coronary artery disease - coronary artery bypass graft operation
 

  • References

  • 1 Moor E, Hamsten A, Blombäck M, Herzfeld I, Wiman B, Ryden L.. Haemostatic factors and inhibitors and coronary artery bypass grafting: preoperative alterations and relations to graft occlusion. Thromb Haemost 1994; 72: 335-42.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Cotton JM, Webb KE, Mathur A, Martin JF, Humphries SE.. Impact of the –455G->A promoter polymorphism in the β fibrinogen gene on stimulated fibrinogen production following bypass surgery. Thromb Haemost 2000; 84: 926-7.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Efthimiadis A, Lefkos N, Psirropoulos D, Papadopoulos I, Boudonas G, Lefkou E, Efthimiadis I, Tsapas G.. Risk factors of ischaemic heart disease and long-term outcome after coronary bypass surgery. J Cardiovasc Surg 2001; 42: 731-4.
    PubMedGoogle Scholar
  • 4 Wilhelmsen L, Svärdsudd K, KorsanBengsten K, Larsson B, Wekin L, Tibblin G.. Fibrinogen as a risk factor for stroke and myocardial infarction. New Engl J Med 1984; 258: 501-5.
    PubMedGoogle Scholar
  • 5 Meade TW, Mellows S, Brozovic M, Miller GJ, Chakrabarti RR, North WRS, Haines AP, Stirling Y, Imeson JD, Thompson SG.. Haemostatic function and ischaemic heart disease: Principle results of the Northwick Park Heart Study. Lancet 1986; II: 533-7.
    PubMedGoogle Scholar
  • 6 Kannel WB, Wolf PA, Castelli WP, D’Agostino RB.. Fibrinogen and risk of cardiovascular disease. JAMA 1987; 258: 1183-6.
    CrossrefPubMedGoogle Scholar
  • 7 Rosengreen A, Wilhelmsen L.. Fibrinogen, coronary heart disease and mortality from all causes in smokers and nonsmokers. The study of men born in 1933. J Internal Med 1996; 239: 499-507.
    CrossrefPubMedGoogle Scholar
  • 8 Rallidis LS, Papageorgakis NH, Megalou AA, Anagnostou ED, Chatzidimitriou GI, Tsitouris GK.. Fibrinogen in the offspring of men with premature coronary artery disease. Eur Heart J 1995; 16: 1814-8.
    CrossrefPubMedGoogle Scholar
  • 9 Thomas AE, Green FR, Lamlum H, Humphries SE.. The association of combined α and β fibrinogen genotype on plasma fibrinogen levels in smokers and non-smokers. J Med Genet 1995; 32: 585-9.
    CrossrefPubMedGoogle Scholar
  • 10 Thomas AE, Green FR, Humphries SE.. Association of genetic variation at the β-fibrinogen gene locus and plasma fibrinogen levels; interaction between allele frequency of the G/A-455 polymorphism, age and smoking. Clin Genet 1996; 50: 184-90.
    PubMedGoogle Scholar
  • 11 Henschen A, Lottspeich F, Kehl M, Southan C.. Covalent structure of fibrinogen. Ann NY Acad Sci 1983; 408: 13-27.
    CrossrefPubMedGoogle Scholar
  • 12 Thomas AE, Green FR, Kelleher CH, Wilkes HC, Brennan PJ, Meade TW, Humphries SE.. Variation in the promoter region of the beta fibrinogen gene is associated with plasma fibrinogen levels in smokers and non-smokers. Thromb Haemost 1991; 65: 487-90.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Scarabin P-Y, Bara L, Ricard S, Poirier O, Cambou JP, Arveiler D, Luc G, Evans AE, Samama MM, Cambien F.. Genetic variation at the β-fibrinogen locus in relation to plasma fibrinogen concentrations and risk of myocar-dial infarction. The ECTIM study. Arterioscler Thromb 1993; 13: 886-91.
    CrossrefPubMedGoogle Scholar
  • 14 Green F, Hamsten A, Blombäck M, Humphries S.. The role of β-fibrinogen genotype in determining plasma fibrinogen levels in young survivors of myocardial infarction and healthy controls from Sweden. Thromb Haemost 1993; 70: 915-20.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Carter AM, Mansfield MW, Stickland MH, Grant PJ.. β-fibrinogen gene –455G/A polymorphism and fibrinogen levels. Risk factors for coronary artery disease in subjects with NIDDM. Diabetes Care 1996; 19: 1265-8.
    CrossrefPubMedGoogle Scholar
  • 16 Behague I, Poirier O, Nicaud V, Evans A, Arveiler D, Luc G, Cambou JP, Scarabin P-Y, Bara L, Green F, Cambien F.. β fibrinogen gene polymorphisms are associated with plasma fibrinogen and coronary artery disease in patients with myocardial infarction. The ECTIM study. Circulation 1996; 93: 440-9.
    CrossrefPubMedGoogle Scholar
  • 17 de Maat MPM, Kastelein JJP, Jukema JW, Zwinderman AH, Jansen H, Groenemeier B, Bruschke AVG, Kluft C.. on the behalf of the REGRESS group. -455G/A polymorphism of the β-fibrinogen gene is associated with the progression of coronary atherosclerosis in symptomatic men Proposed role for an acute-phase reaction pattern of fibrinogen. Arterioscler Thromb Vasc Biol 1998; 18: 265-71.
    CrossrefPubMedGoogle Scholar
  • 18 Kessler C, Spitzer C, Stauske D, Mende S, Stadlmüller J, Walther R, Rettig R.. The apolipoprotein E and the β-fibrinogen G/A-455 gene polymorphisms are associated with ischemic stroke involving large vessel disease. Arterioscler Thromb Vasc Biol 1997; 17: 2880-4.
    CrossrefPubMedGoogle Scholar
  • 19 Wang XL, Wang J, McCredie RM, Wilcken DEL.. Polymorphisms of factor V, factor VII and fibrinogen genes. Relevance to severity of coronary artery disease. Arterioscler Thromb Vasc Biol 1997; 17: 246-51.
    CrossrefPubMedGoogle Scholar
  • 20 Völzke H, Engel J, Kleine V, Schwahn C, Dahm JB, Eckel L, Rettig R.. Angiotensin I-converting enzyme insertion/deletion polymorphism and cardiac mortality and morbidity after coronary artery bypass graft surgery. Chest 2002; 122: 31-6.
    CrossrefPubMedGoogle Scholar
  • 21 Clauss A.. Gerinnungsphysiologische Schnellmethode zur Bestimmung des Fibrinogens. Acta Haemat 1957; 17: 237-46.
    CrossrefPubMedGoogle Scholar
  • 22 Cheshire NJ, Wolfe JH, Barradas MA, Chambler AW, Mikhailidis DP.. Smoking and plasma fibrinogen, lipoprotein (a) and serotonin are markers for postoperative infrainguinal graft stenosis. Eur J Vasc Endovasc Surg 1996; 11: 479-86.
    CrossrefPubMedGoogle Scholar
  • 23 Risum O, Nitter-Hauge S, Abdelnoor M, Levorstad K, Arafa O, Svennevig JL.. Mortality and morbidity after coronary artery bypass surgery related to pre-operative left ventricular ejection fraction. Eur Heart J 1996; 17: 874-9.
    CrossrefPubMedGoogle Scholar
  • 24 Brandrup-Wognsen G, Haglid M, Karlsson T, Berggren H, Herlitz J.. Mortality during the two years after coronary artery bypass grafting in relation to perioperative factors and urgency of operation. Eur J Cardiothorac Surg 1995; 9: 685-91.
    CrossrefPubMedGoogle Scholar
  • 25 Thourani VH, Weintraub WS, Stein B, Geb-hart SSP, Craver JM, Jones EL, Guyton RA.. Influence of diabetes mellitus on early and late outcome after coronary artery bypass grafting. Ann Thorac Surg 1999; 67: 1045-52.
    CrossrefPubMedGoogle Scholar
  • 26 Gardemann A, Schwartz O, Haberbosch W, Katz N, Weiss T, Tillmanns H, Hehrlein FW, Waas W, Eberbach A.. Positive association of the beta fibrinogen H1/H2 gene variation to basal fibrinogen levels and to the increase in fibrinogen concentration during acute phase reaction but not to coronary artery disease and myocardial infarction. Thromb Haemost 1997; 77: 1120-6.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Montgomery HE, Clarkson P, Nwose OM, Mikailidis DP, Jagroop IA, Dollery C, Moult J, Benhizia F, Deanfield J, Jubb M, World M, McEwan JR, Winder A, Humphries S.. The acute rise in plasma fibrinogen concentration with exercise is influenced by the G-453-A polymorphism of the beta-fibrinogen gene. Arterioscler Thromb Vasc Biol 1996; 16: 386-91.
    CrossrefPubMedGoogle Scholar
  • 28 Almasy L, Mac Cluer JW... Association studies of vascular phenotypes. How and why?. Arterioscler Thromb Vasc Biol 2002; 22: 1055-7.
    CrossrefPubMedGoogle Scholar
  • 29 Palatianos GM, Bolooki H, Horowitz MD, Lowery MH, Rosenthal SP, Chandarlapaty SK, Sfakianakis GN, Kaiser GA.. Sequential internal mammary artery grafts for coronary artery bypass. Ann Thorac Surg 1993; 56: 1136-40.
    CrossrefPubMedGoogle Scholar
  • 30 Edwards FH, Clark RE, Schwartz M.. Impact of internal mammary conduits on operative mortality in coronary revascularization. Ann Thorac Surg 1994; 57: 27-32.
    CrossrefPubMedGoogle Scholar
  • 31 van Brussel BL, Ernst JM, Ernst NM, Kelder HC, Knaepen PJ, Plokker HWM, Vermeulen FE, Voors AA.. Clinical outcome in venous coronary artery bypass grafting: a 15-year follow-up study. Int J Cardiol 1997; 58: 119-26.
    CrossrefPubMedGoogle Scholar
  • 32 Sergeant P, Blackstone E, Meyns B.. Validation and interdependence with patient-variables of the influence of procedural variables on early and late survival after CABG. K.U. Leuven Coronary Surgery Program. Eur J Cardiothorac Surg 1997; 12: 1-19.
    CrossrefPubMedGoogle Scholar
  • 33 Herlitz J, Brandrup-Wognsen G, Haglid M, Hartford M, Emanuelsson H, Karlson BW, Karlsson T, Hjalmarson A.. Mortality and morbidity during a period of 2 years after coronary artery bypass surgery in patients with and without a history of hypertension. J Hypertens 1996; 14: 309-14.
    CrossrefPubMedGoogle Scholar