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This analysis aimed to evaluate prognostic value of thrombogenicity profiles and coronary anatomy for cardiovascular events in patients undergoing non-cardiac surgery. In a prospective cohort of 120 patients who underwent intermediate-to-high risk surgery, thrombogenicity profiles were assessed using thromboelastography (TEG\u00ae) and conventional hemostatic measurements before surgery. Coronary artery disease (CAD) was preoperatively defined as presence of significant stenosis (\u2265\u200950% luminal narrowing) on coronary computed tomography angiography (CCTA). Postoperative cardiovascular events were defined as cardiovascular death, non-fatal myocardial infarction, myocardial injury, pulmonary edema, non-fatal stroke, and systemic embolism within 30\u00a0days after surgery. Sixteen patients (13.3%) experienced cardiovascular events. In multivariable analysis, presence of CAD (odds ratio [OR]: 5.11; 95% confidence interval [CI]: 1.49\u201317.53;\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.009), D-dimer (per 1-\u03bcg\/mL increase: OR: 1.22; 95% CI: 1.02\u20131.47;\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.030), and platelet\u2013fibrin clot strength (PFCS) measured by TEG\u00ae (per 1-mm increase: OR: 1.10; 95% CI: 1.01\u20131.20;\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.027) were independently associated with cardiovascular events. Discrimination of cardiovascular event risk improved progressively with the sequential addition of the following risk stratification models: RCRI alone, RCRI\u2009+\u2009CCTA, and RCRI\u2009+\u2009CCTA\u2009+\u2009thrombogenicity profiles (C-index: 0.660 vs. 0.731 vs. 0.803). Cardiovascular event rates increased with greater risk burden, ranging from 4.2% in patients with no risk components to 77.8% in those with all components present. Integrating thrombogenicity assessment and CCTA with traditional clinical risk models may improve perioperative risk stratification and help guide tailored preventive strategies for patients undergoing non-cardiac surgery.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Clinical trial registration<\/jats:italic>\n                    . URL:\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/www.clinicaltrials.gov\" ext-link-type=\"uri\">http:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                    . Unique identifier: NCT02250963.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Graphical Abstract<\/jats:bold>\n                  <\/jats:p>\n                  <jats:p>Sequential integration of thrombogenicity profiles and coronary anatomy assessed by CCTA improves perioperative cardiovascular risk prediction beyond clinical risk stratification alone in patients undergoing non-cardiac surgery. CAD\u2009=\u2009coronary artery disease; CCTA\u2009=\u2009coronary computed tomography angiography; CI\u2009=\u2009confidence interval; CV\u2009=\u2009cardiovascular; MI\u2009=\u2009myocardial infarction; MINS\u2009=\u2009myocardial injury in non-cardiac surgery; PFCS\u2009=\u2009platelet\u2013fibrin clot strength; RCRI\u2009=\u2009Revised Cardiac Risk Index; TEG\u00ae\u2009=\u2009thromboelastography.<\/jats:p>","DOI":"10.1007\/s11239-026-03299-z","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T06:35:52Z","timestamp":1779086152000},"page":"1349-1361","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Association of thrombogenicity indices with perioperative cardiovascular events after non-cardiac surgery: a prespecified analysis of the PANDA study"],"prefix":"10.1007","volume":"59","clinical-trial-number":[{"clinical-trial-number":"nct02250963","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Hendrianus","family":"Hendrianus","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jong-Hwa","family":"Ahn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min-Gyu","family":"Kang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kye-Hwan","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin-Sin","family":"Koh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang-Wook","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin-Yong","family":"Hwang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Udaya S.","family":"Tantry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A.","family":"Gurbel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeong-Rang","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9479-2822","authenticated-orcid":false,"given":"Young-Hoon","family":"Jeong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"3299_CR1","doi-asserted-by":"publisher","first-page":"2258","DOI":"10.1056\/NEJMra1502824","volume":"373","author":"PJ Devereaux","year":"2015","unstructured":"Devereaux PJ, Sessler DI (2015) Cardiac complications in patients undergoing major noncardiac surgery. 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Dr Jeong has received honoraria for lectures from Daiichi Sankyo, Sanofi-Aventis, Han-mi Pharmaceuticals, and Daewoong Pharmaceuticals and research grants or support from Samjin Pharmaceuticals, Hanmi Pharmaceuticals, Yuhan Pharmaceuticals, Biotronik Korea, and U and I Corporation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.","order":1,"name":"Ethics","label":"Competing interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}