BACKGROUND Deep sternal wound/mediastinitis is a rare but feared complication in CABG (coronary artery bypass grafting) patients and seems to increase the risk of cardiac death, and is also associated with the risk of early internal mammary artery (IMA) graft obstruction. The pathological mechanism explaining the link between mediastinitis and IMA graft obstruction and the impact on mortality is complex, multifactorial and not fully investigated. Mediastinitis has been associated with increased concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP) and troponin T (TnT) at mid-term follow-up, representing persistent low-grade myocardial injury and impaired cardiac function. However, whether mediastinitis is associated with all-cause mortality, or whether the association is driven by these cardiac-specific biomarkers (NT-proBNP and TnT), is not investigated. SUMMARY The present study provides the longest and most complete follow-up data in 82 patient undergoing CABG, including 41 with post-sternotomy mediastinitis. The annualized incidence rate of mediastinitis was 0.14%/year and remained stable at 0.14% throughout the study period. During a mean follow-up of 12.7±3.5 years, a total of 42 deaths occurred (27 [65.9%] in mediastinitis and 15 [36.6%] in non-mediastinitis group, p=0.008). Patients who died were older, had lower eGFR and higher prevalence of atrial fibrillation, and were more likely to have higher systolic BP compared to patients who were alive. KEY MESSAGES Mediastinitis after CABG surgery was associated with a poor prognosis during a 15-year follow-up, showing a nearly two-fold higher frequency of all-cause mortality compared with non-mediastinitis group, with the differences in mortality rate occurring primarily after 10 years. The association between mediastinitis and all-cause mortality was modulated by subclinical myocardial damage and stretch, reflected by elevated TnT and NT-proBNP, measured at 2.7 year follow-up, underscoring that these could represent prognostic markers in CABG patients.

中文翻译：

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肌钙蛋白 T 和 N 末端脑钠肽前体与冠状动脉旁路移植术后胸骨切开术后纵隔炎患者的长期全因死亡率相关：一项 15 年随访研究。

背景 深部胸骨伤口/纵隔炎是 CABG（冠状动脉旁路移植术）患者罕见但令人担忧的并发症，似乎会增加心源性死亡的风险，并且还与早期乳内动脉（IMA）移植物阻塞的风险相关。解释纵隔炎和 IMA 移植物梗阻之间联系及其对死亡率影响的病理机制是复杂的、多因素的，且尚未得到充分研究。纵隔炎与中期随访时 N 端脑钠肽原 (NT-proBNP) 和肌钙蛋白 T (TnT) 浓度升高有关，代表持续的低度心肌损伤和心功能受损。然而，纵隔炎是否与全因死亡率相关，或者这种关联是否由这些心脏特异性生物标志物（NT-proBNP 和 TnT）驱动，尚未得到研究。总结 本研究提供了 82 名接受 CABG 患者的最长、最完整的随访数据，其中 41 名患者患有胸骨切开术后纵隔炎。纵隔炎的年发病率为 0.14%/年，并在整个研究期间稳定在 0.14%。在平均 12.7±3.5 年的随访期间，共有 42 例死亡（纵隔炎组 27 例 [65.9%]，非纵隔炎组 15 例 [36.6%]，p=0.008）。与活着的患者相比，死亡患者年龄较大、eGFR 较低、心房颤动患病率较高，并且收缩压更有可能较高。关键信息 CABG 术后纵隔炎与 15 年随访期间的不良预后相关，与非纵隔炎组相比，全因死亡率高出近两倍，死亡率差异主要发生在术后10年。纵隔炎与全因死亡率之间的关联受到亚临床心肌损伤和牵张的调节，通过 2.7 年随访时测量的 TnT 和 NT-proBNP 升高来反映，强调这些可以代表 CABG 患者的预后标志物。