Background <p>Little is known about the role of D-dimer (DD) on the prognosis of patients undergoing coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG).</p> Methods <p>A total of 371 patients undergoing CE with CABG between January 2018 and July 2022 were retrospectively enrolled. The primary endpoint was the perioperative major adverse cardiovascular and cerebrovascular events (MACCE). Univariate logistic regression was performed to detect the relationship between preoperative DD level and the occurrence of perioperative MACCE. Receiver operating characteristics method was applied to determine the optimal cut-off threshold, while the multivariable logistic regression analysis was used to adjust the potential confounders.</p> Results <p>Univariate logistic regression revealed that preoperative DD level was associated with increased risk of perioperative MACCE. The optimal cut-off for DD was 0.235&#xa0;µg/ml. More patients in the high DD group suffered from perioperative MACCE than the low DD group (13.2% vs. 3.9%, <i>P</i> = 0.004), even after multiple adjustment (odds ratio [OR]: 2.93, 95% confidence interval [CI]: 1.07–8.04, <i>P</i> = 0.036) in the multivariable logistic analysis. The occurrence of perioperative myocardial infarction was also much higher in high DD group (3.1% vs. 11.2%, <i>P</i> = 0.013).</p> Conclusions <p>In conclusion, high preoperative DD levels might predict an increased risk of perioperative adverse events after CE with CABG.</p>