Preoperative peripheral blood CD4/CD8 ratio in predicting the prognosis of patients with coronary atherosclerotic heart disease after off-pump coronary artery bypass grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHU Chenghao , ZHANG Chengxin , ZHU Rui , LI Xin ,  GE Shenglin

Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, P.R.China;

Corresponding author：

GE Shenglin, Email: aydgsl@sina.com

Keywords：

Coronary atherosclerotic heart disease; CD4/CD8 ratio; off-pump coronary artery bypass grafting; prognosis

DOI：

10.7507/1007-4848.201906044

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the role of preoperative peripheral blood CD4/CD8 ratio in predicting the prognosis of patients with coronary atherosclerotic heart disease (CAD) after off-pump coronary artery bypass grafting (OPCABG).Methods A total of 118 patients with CAD who underwent OPCABG in our hospital from September 2016 to April 2017 were included in the study, including 82 males and 36 females aged 62.74±4.50 years. The primary end point was the incidence of major adverse cardiovascular events (MACE). Patients were divided into a high CD4/CD8 group (≥1.40, 62 patients) and a low CD4/CD8 group (<1.40, 56 patients) according to the results of flow cytometry. The correlation between CD4/CD8 ratio and prognosis of patients after OPCABG and the value of CD4/CD8 ratio for predicting postoperative MACE were evaluated.Results Median duration of follow-up was 23.25 (20.91, 24.70) months, during which 21 patients (17.80%) experienced MACE and 4 patients (3.39%) were lost to follow-up. Kaplan-Meier analysis revealed that high CD4/CD8 group had a significantly higher MACE rate than the low CD4/CD8 group did (log-rank χ²=5.797, P=0.02). The results of adjusted Cox proportional hazards model showed that CD4/CD8 ratio (HR=3.103, 95%CI 1.557-6.187, P<0.01) was an independent risk factor of MACE in patients with CAD after OPCABG. The receiver operating characteristic curve showed that area under curve was 0.778 (95%CI 0.661-0.894, P<0.01), the optimal cut off value was 2.24, the sensitivity was 57.1%, and the specificity was 87.6%.Conclusion Preoperative peripheral blood CD4/CD8 ratio is an independent predictor of MACE after OPCABG in patients with CAD.

Citation： CHU Chenghao, ZHANG Chengxin, ZHU Rui, LI Xin, GE Shenglin. Preoperative peripheral blood CD4/CD8 ratio in predicting the prognosis of patients with coronary atherosclerotic heart disease after off-pump coronary artery bypass grafting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(1): 20-25. doi: 10.7507/1007-4848.201906044 Copy

1.	Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859): 2095-2128.
2.	Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med, 2005, 352(16): 1685-1695.
3.	Gisterå A, Hansson GK. The immunology of atherosclerosis. Nat Rev Nephrol, 2017, 13(6): 368-380.
4.	Blasi C. The autoimmune origin of atherosclerosis. Atherosclerosis, 2008, 201(1): 17-32.
5.	Hansson GK. The immune system in atherosclerosis. Nat Immunol, 2011, 12(3): 204-212.
6.	Zhou XH. CD4+ T cells in atherosclerosis. Biomed Pharmacother, 2003, 57(7): 287-291.
7.	Chyu KY, Zhao X, Dimayuga PC, et al. CD8+ T cells mediate the athero-protective effect of immunization with an ApoB-100 peptide. PLoS One, 2012, 7(2): e30780.
8.	Zhou L, Song H, Xu W, et al. Immune function of peripheral T cells in patients with venous thromboembolism or coronary artery atherosclerosis. Rev Port Cardiol, 2014, 33(6): 339-344.
9.	van Dijk RA, Duinisveld AJF, Schaapherder AF, et al. A change in inflammatory footprint precedes plaque instability: a systematic evaluation of cellular aspects of the adaptive immune response in human atherosclerosis. J Am Heart Assoc, 2015, 4(4): e001403.
10.	Gao P, Rong HH, Lu T, et al. The CD4/CD8 ratio is associated with coronary artery disease (CAD) in elderly Chinese patients. Int Immunopharmacol, 2017, 42: 39-43.
11.	Brunetti ND, D’Antuono C, Rana M, et al. Lymphocyte subset characterization in patients with early clinical presentation of coronary heart disease. J Thromb Thrombolysis, 2012, 34(4): 475-482.
12.	Yan W, Song Y, Zhou L, et al. Immune cell repertoire and their mediators in patients with acute myocardial infarction or stable angina pectoris. Int J Med Sci, 2017, 14(2): 181-190.
13.	Yu C, Chen M, Chen Z, et al. Predictive and prognostic value of admission neutrophil-to-lymphocyte ratio in patients with CHD. Herz, 2016, 41(7): 605-613.
14.	Lamy A, Devereaux PJ, Prabhakaran D, et al. Off-pump or on-pump coronary-artery bypass grafting at 30 days. N Engl J Med, 2012, 366(16): 1489-1497.
15.	Yamasaki M, Deb S, Tsubota H, et al. Comparison of radial artery and saphenous vein graft stenosis more than 5 years after coronary artery bypass grafting. Ann Thorac Surg, 2016, 102(3): 712-719.
16.	Bruno G, Saracino A, Monno L, et al. The revival of an "old" marker: CD4/CD8 ratio. AIDS Rev, 2017, 19(2): 81-88.
17.	Ruggio A, Pedicino D, Flego D, et al. Correlation between CD4(+)CD28(null) T lymphocytes, regulatory T cells and plaque rupture: an optical coherence tomography study in acute coronary syndromes. Int J Cardiol, 2019, 276: 289-292.
18.	Jose R, Shetty A, Krishna N, et al. Early and mid‐term outcomes of patients undergoing coronary artery bypass grafting in ischemic cardiomyopathy. J Am Heart Assoc, 2019, 8(10): e010225.
19.	Yi G, Joo HC, Yoo KJ. Impact of preoperative C-reactive protein on midterm outcomes after off-pump coronary artery bypass grafting. Thorac Cardiovasc Surg, 2013, 61(8): 682-686.
20.	Koppen E, Madsen E, Greiff G, et al. Perioperative factors associated with changes in troponin t during coronary artery bypass grafting. J Cardiothorac Vasc Anesth, 2019, 33(12): 3309-3319.

1. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859): 2095-2128.
2. Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med, 2005, 352(16): 1685-1695.
3. Gisterå A, Hansson GK. The immunology of atherosclerosis. Nat Rev Nephrol, 2017, 13(6): 368-380.
4. Blasi C. The autoimmune origin of atherosclerosis. Atherosclerosis, 2008, 201(1): 17-32.
5. Hansson GK. The immune system in atherosclerosis. Nat Immunol, 2011, 12(3): 204-212.
6. Zhou XH. CD4+ T cells in atherosclerosis. Biomed Pharmacother, 2003, 57(7): 287-291.
7. Chyu KY, Zhao X, Dimayuga PC, et al. CD8+ T cells mediate the athero-protective effect of immunization with an ApoB-100 peptide. PLoS One, 2012, 7(2): e30780.
8. Zhou L, Song H, Xu W, et al. Immune function of peripheral T cells in patients with venous thromboembolism or coronary artery atherosclerosis. Rev Port Cardiol, 2014, 33(6): 339-344.
9. van Dijk RA, Duinisveld AJF, Schaapherder AF, et al. A change in inflammatory footprint precedes plaque instability: a systematic evaluation of cellular aspects of the adaptive immune response in human atherosclerosis. J Am Heart Assoc, 2015, 4(4): e001403.
10. Gao P, Rong HH, Lu T, et al. The CD4/CD8 ratio is associated with coronary artery disease (CAD) in elderly Chinese patients. Int Immunopharmacol, 2017, 42: 39-43.
11. Brunetti ND, D’Antuono C, Rana M, et al. Lymphocyte subset characterization in patients with early clinical presentation of coronary heart disease. J Thromb Thrombolysis, 2012, 34(4): 475-482.
12. Yan W, Song Y, Zhou L, et al. Immune cell repertoire and their mediators in patients with acute myocardial infarction or stable angina pectoris. Int J Med Sci, 2017, 14(2): 181-190.
13. Yu C, Chen M, Chen Z, et al. Predictive and prognostic value of admission neutrophil-to-lymphocyte ratio in patients with CHD. Herz, 2016, 41(7): 605-613.
14. Lamy A, Devereaux PJ, Prabhakaran D, et al. Off-pump or on-pump coronary-artery bypass grafting at 30 days. N Engl J Med, 2012, 366(16): 1489-1497.
15. Yamasaki M, Deb S, Tsubota H, et al. Comparison of radial artery and saphenous vein graft stenosis more than 5 years after coronary artery bypass grafting. Ann Thorac Surg, 2016, 102(3): 712-719.
16. Bruno G, Saracino A, Monno L, et al. The revival of an "old" marker: CD4/CD8 ratio. AIDS Rev, 2017, 19(2): 81-88.
17. Ruggio A, Pedicino D, Flego D, et al. Correlation between CD4(+)CD28(null) T lymphocytes, regulatory T cells and plaque rupture: an optical coherence tomography study in acute coronary syndromes. Int J Cardiol, 2019, 276: 289-292.
18. Jose R, Shetty A, Krishna N, et al. Early and mid‐term outcomes of patients undergoing coronary artery bypass grafting in ischemic cardiomyopathy. J Am Heart Assoc, 2019, 8(10): e010225.
19. Yi G, Joo HC, Yoo KJ. Impact of preoperative C-reactive protein on midterm outcomes after off-pump coronary artery bypass grafting. Thorac Cardiovasc Surg, 2013, 61(8): 682-686.
20. Koppen E, Madsen E, Greiff G, et al. Perioperative factors associated with changes in troponin t during coronary artery bypass grafting. J Cardiothorac Vasc Anesth, 2019, 33(12): 3309-3319.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Preoperative peripheral blood CD4/CD8 ratio in predicting the prognosis of patients with coronary atherosclerotic heart disease after off-pump coronary artery bypass grafting

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