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Gene Linked with Death After Coronary Bypass Surgery

A genetic variant involved in blood clotting and inflammation has been linked to a lower five-year survival rate for those who have coronary artery bypass surgery, according to new research.

The findings should be used to better treat and ensure the survival of these surgical patients over the long-term, said the research team from Duke University Medical Center in Durham, N.C.

The scientists found the same gene was associated with mortality in two different sets of patients, with about 1,000 patients in each group (1,018 and 930 patients, respectively).

"After the second analysis, we were ecstatic to see this was validated," said senior author Dr. Mihai Podgoreanu, assistant professor of anesthesiology at Duke, in a news release. "This is the first study I know about in the field of perioperative medicine to show increased genetic susceptibility for long-term mortality while replicating the genetic association in an independent cohort."

The team found common variants in the thrombomodulin (THBD) gene, involved in regulation of blood coagulation and inflammation, to be independently associated with increased long-term mortality risk following a coronary artery bypass graft (CABG) procedure, after accounting for currently known risk factors.

"In any biomarker association study, current wisdom is that there are a lot of false positive findings, so we used specimens from a different, independent cohort of patients to increase our confidence that the initial results were not spurious," Podgoreanu said.

"This finding has the potential to significantly improve the classification ability of traditional mortality-prediction models after a patient's open heart surgery," Podgoreanu said.

He said the findings open up the field for more work, but it is too soon to say how this genetic finding should be used to benefit individual cardiac surgical patients and extend their survival. It's also too soon for great numbers of people to have their genomes sequenced and learn whether they carry this particular gene variant.

That said, Podgoreanu does see ways in which the finding might help patients.

"We need to work to find uses for any sort of biomarker," he explained. "There are possibilities that we could apply this information someday to a patient's prognosis, and for careful monitoring or increased surveillance if a person has a 2.5 times higher risk of dying, instead of letting them go their way after a CABG surgery."

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