Pretorius Mias, Donahue Brian S, Yu Chang, Greelish James P, Roden Dan M, Brown Nancy J
Department of Anesthesiology, Vanderbilt University Medical School, Nashville, TN 37232, USA.
Circulation. 2007 Sep 11;116(11 Suppl):I1-7. doi: 10.1161/CIRCULATIONAHA.106.677906.
Postoperative atrial fibrillation (AF), leading to significant morbidity and prolongation of hospital stay, complicates 20% to 40% of surgical procedures requiring cardiopulmonary bypass (CPB). This study tests the hypothesis that biomarkers predict the development of postoperative AF.
We enrolled 253 adult patients undergoing elective cardiac surgery requiring CPB and who were in sinus rhythm at the time of surgery. Blood samples were obtained for measurement of 21 biomarkers immediately after separation from CPB and administration of protamine. Patients who developed postoperative AF (67 subjects, 26.5%) were significantly older (P<0.001), more likely to have a remote history of AF (P<0.001), and tended to be more likely to have had valve surgery (P=0.082). Plasminogen activator inhibitor-1 (P=0.014), interleukin (IL)-6 (P=0.019), and N-terminal prohormone brain natriuretic peptide (P=0.028) concentrations were significantly higher in the blood of patients who developed postoperative AF. Logistic regression identified age (P<0.001), remote history of AF (P=0.001), and postoperative PAI-1 (P=0.036) as independent predictors of postoperative AF. When preoperative PAI-1 antigen concentrations were included in the model age (P<0.001), remote history of AF (P<0.001) and preoperative PAI-1 (P=0.015) were identified as independent predictors of postoperative AF. The Chi-squared Automatic Interaction Detection (CHAID) model indicated that age was the primary determinant for the development of postoperative AF (17% in age < or = 67.3 years versus 49% in age > 67.3 years). Within younger patients (age < or = 67.3 years) without remote history of AF, postoperative PAI-1 antigen concentration next determined risk of AF (13% if PAI-1 < or = 28.5 ng/mL versus 46% if PAI-1 > 28.5 ng/mL).
An elevated preoperative or postoperative PAI-1 antigen concentration is an independent predictor for development of AF after CPB. Studies are needed to determine whether drugs that reduce PAI-1 concentrations can also reduce the risk of postoperative AF.
术后房颤（AF）会导致显著的发病率增加和住院时间延长，在20%至40%需要体外循环（CPB）的外科手术中是一种并发症。本研究检验生物标志物可预测术后房颤发生的假设。
我们纳入了253例接受择期心脏手术且需要CPB的成年患者，这些患者在手术时处于窦性心律。在与CPB分离并给予鱼精蛋白后立即采集血样以检测21种生物标志物。发生术后房颤的患者（67例，26.5%）年龄显著更大（P<0.001），更可能有房颤既往史（P<0.001），并且倾向于更可能接受过瓣膜手术（P=0.082）。术后发生房颤患者血液中的纤溶酶原激活物抑制剂-1（P=0.014）、白细胞介素（IL）-6（P=0.019）和N末端脑钠肽前体（P=0.028）浓度显著更高。逻辑回归分析确定年龄（P<0.001）、房颤既往史（P=0.001）和术后PAI-1（P=0.036）是术后房颤的独立预测因素。当将术前PAI-1抗原浓度纳入模型时，年龄（P<0.001）、房颤既往史（P<0.001）和术前PAI-1（P=0.015）被确定为术后房颤的独立预测因素。卡方自动交互检测（CHAID）模型表明年龄是术后房颤发生的主要决定因素（年龄≤67.3岁者为17%，年龄>6岁者为49%）。在无房颤既往史的年轻患者（年龄≤67.3岁）中，术后PAI-1抗原浓度接下来决定房颤风险（如果PAI-1≤28.5 ng/mL，房颤风险为13%；如果PAI-1>28.5 ng/mL，房颤风险为46%）。
术前或术后PAI-1抗原浓度升高是CPB后房颤发生的独立预测因素。需要开展研究以确定降低PAI-1浓度的药物是否也能降低术后房颤风险。
