Qian Su,* Zhipeng Deng,* Xiangqing Wei, Lu Li, Boxiang Du, Fei Guo, Yi Gu, Jie Song, Lei Yao

Department of Anesthesiology, Affiliated Hospital 2 of Nantong University, Nantong, 226001, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Lei Yao; Jie Song, Department of Anesthesiology, Affiliated Hospital 2 of Nantong University, No. 666 Shengli Road, Nantong, 226001, People’s Republic of China, Tel +86 18862920110 ; +86 13806298162, Email yaoleijiangsu1987@ntu.edu.cn; songjie1004@sina.com

Background: The identification of predictors for major adverse cardiovascular events (MACEs) is essential for reducing mortality associated with off-pump coronary artery bypass grafting (OPCAB). The objective of this study is to assess serum periostin levels as a novel predictor of MACEs in patients undergoing OPCAB.
Methods: This prospective study included 79 patients diagnosed with coronary artery disease (CAD) who underwent OPCAB between May 2022 and May 2023. The changes in periostin levels (ΔPOSTN) were calculated using the formula: postoperative POSTN levels minus preoperative POSTN levels. Based on the optimal cut-off value determined from the receiver operating characteristic (ROC) curve, patients were categorized into Low POSTN Change (LPC) and High POSTN Change (HPC) groups for subgroup analysis. The primary outcomes assessed were MACEs, including cardiac death, myocardial infarction (MI), heart failure, and stroke.
Results: Follow up for the patients was conducted for 30 days, with 71 patients ultimately being included in the final analysis. During this period, 13 MACEs were recorded, representing an incidence rate of 18.3%. The events included 2 cases of cardiac death (2.8%), 5 cases of MI (7.0%), 5 cases of heart failure (7.0%), and 1 case of stroke (1.4%). The risk of MACEs increased by 4% for each unit increase in the ΔPOSTN (Odds Ratio [OR]: 1.04, 95% Confidence Interval [CI]: 1.01– 1.06; p = 0.005). The area under the ROC curve was 0.869 (95% CI: 0.768– 0.938; p < 0.001). Based on the Youden index (J = 0.683), the optimal threshold for ΔPOSTN was determined to be 16.6 μg/L, with a sensitivity of 76.9% and a specificity of 91.4%.
Conclusion: Changes in serum periostin levels during the perioperative period may serve as an independent predictor of 30-day MACEs in patients undergoing OPCAB.
Trial Registration: Link of the registry: https://www.chictr.org.cn. Date of registration: 2022/05/22. Trial registration number: ChiCTR2200060220.

Keywords: MACE, myocardial infarction, OPCAB, serum periostin, ventricular remodeling