背景:心脏手术会触发无菌的先天免疫反应,导致术后并发症。克隆造血(CH)与心脏手术后短期炎症介导的结果有关。CH对长期术后结局的影响尚不清楚。
结果:在这项队列研究中,纳入了2017年1月至2019年9月接受择期心脏手术的患者.使用19个基因的预定基因组筛选患者的CH。记录的临床事件为全因死亡,主要心脏和大脑不良事件,包括心血管死亡,心肌梗死或非计划冠状动脉血运重建,中风,和急性心力衰竭住院治疗。主要研究结果是达到复合标准的时间,包括全因死亡率和主要不良心脑事件。在314名基因分型患者中(中位年龄:67岁;四分位距59-74岁),139(44%)提供CH,基于变异等位基因频率≥1%。CH携带者有房颤病史的患者比例较高(CH为26%,非CH携带者为17%,P=0.022)。最常见的突变基因是DNMT3A,TET2和ASXL1。经过1203[813-1435]天的中位随访,主要结局发生在50例患者中.经过多变量调整后,CH与主要结局的较高风险独立相关(风险比,1.88[95%CI,1.05-3.41],P=0.035)。大多数不良事件发生在携带TET2变体的患者中。
结论:在接受心脏手术的患者中,CH是常见的,并且与主要不良临床结局的长期风险增加2倍相关。CH是长期心脏手术后并发症的新风险因素,可能有助于个性化管理决策。
背景:URL:https://www。clinicaltrials.gov;唯一标识符:NCT03376165。
BACKGROUND: Cardiac surgery triggers sterile innate immune responses leading to postoperative complications. Clonal hematopoiesis (CH) is associated with short-term inflammation-mediated outcomes after cardiac surgery. The impact of CH on long-term postoperative outcomes remains unknown.
RESULTS: In this cohort study, patients undergoing elective cardiac surgery were included from January 2017 to September 2019. Patients were screened for CH using a predefined gene panel of 19 genes. Recorded clinical events were all-cause death, major adverse cardiac and cerebral events including cardiovascular death, myocardial infarction or nonscheduled coronary revascularization, stroke, and hospitalization for acute heart failure. The primary study outcome was time to a composite criterion including all-cause mortality and major adverse cardiac and cerebral events. Among 314 genotyped patients (median age: 67 years; interquartile range 59-74 years), 139 (44%) presented with CH, based on a variant allelic frequency ≥1%. Carriers of CH had a higher proportion of patients with a history of atrial fibrillation (26% for CH versus 17% for non-CH carriers, P=0.022). The most frequently mutated genes were DNMT3A, TET2, and ASXL1. After a median follow-up of 1203 [813-1435] days, the primary outcome occurred in 50 patients. After multivariable adjustment, CH was independently associated with a higher risk for the primary outcome (hazard ratio, 1.88 [95% CI, 1.05-3.41], P=0.035). Most adverse events occurred in patients carrying TET2 variants.
CONCLUSIONS: In patients undergoing cardiac surgery, CH is frequent and associated with a 2-fold increased long-term risk for major adverse clinical outcomes. CH is a novel risk factor for long-term postcardiac surgery complications and might be useful to personalize management decisions.
BACKGROUND: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03376165.