Echahidi Najmeddine, Mohty Dania, Pibarot Philippe, Després Jean-Pierre, O'Hara Gilles, Champagne Jean, Philippon François, Daleau Pascal, Voisine Pierre, Mathieu Patrick
Department of Medicine, Laval University, Quebec, Canada.
Circulation. 2007 Sep 11;116(11 Suppl):I213-9. doi: 10.1161/CIRCULATIONAHA.106.681304.
Postoperative atrial fibrillation (POAF) is a highly prevalent complication after cardiac surgery with substantial effects on outcomes. Previous studies have reported that obesity is a risk factor for POAF after cardiac surgery. However, it is unknown whether the metabolic syndrome (MS) also increases the risk of postoperative atrial fibrillation.
We retrospectively analyzed the association between obesity and MS and the incidence of new-onset POAF in a total of 5085 patients who underwent isolated coronary artery bypass grafting surgery with no concomitant valvular surgery. Of these patients, 1468 (29%) were obese (body mass index > or = 30 kg/m2) and 2320 (46%) had a MS as defined by the NCEP-ATPIII. POAF occurred in 1374 (27%) of the patients. Obesity was associated (P<0.001) with increased incidence of POAF in the whole cohort as well as in patients > 50 years old but not in patients < or = 50 years old. In these patients, MS was the only metabolic factor to be significantly associated with higher incidence of POAF (12% versus 6%, P=0.01). In > 50-year-old patients, mild (30 < or = body mass index < 35 kg/m2) and moderate-severe (body mass index > or = 35 kg/m2) obesity were independently associated with a 1.4-fold (95% CI: 1.10 to 1.71; P=0.004) and 2.3-fold (95% CI: 1.71 to 3.13; P<0.0001) increase in the risk of POAF, respectively. In < or = 50-year-old patients, MS (relative risk [RR]: 2.36; 95% CI: 1.10 to 5.12; P=0.02) but not obesity was independently associated with POAF.
This study demonstrates that obesity is a powerful risk factor for the occurrence of POAF after isolated coronary artery bypass grafting surgery in patients older than 50 years. However, in the younger population, this association is not observed and MS is the only metabolic risk factor to be independently associated with POAF.
术后房颤（POAF）是心脏手术后一种非常常见的并发症，对手术结果有重大影响。既往研究报道肥胖是心脏手术后发生POAF的一个危险因素。然而，代谢综合征（MS）是否也会增加术后房颤的风险尚不清楚。
我们回顾性分析了共5085例接受单纯冠状动脉旁路移植术且未同期进行瓣膜手术患者中肥胖与MS和新发POAF发生率之间的关联。在这些患者中，1468例（29%）肥胖（体重指数≥30kg/m²），2320例（46%）符合美国国家胆固醇教育计划成人治疗小组第三次报告（NCEP-ATPIII）定义的MS。1374例（27%）患者发生了POAF。肥胖与整个队列以及年龄>50岁患者中POAF发生率增加相关（P<0.001），但在年龄≤50岁患者中并非如此。在这些患者中，MS是唯一与POAF较高发生率显著相关的代谢因素（12%对6%，P=0.01）。在年龄>50岁的患者中，轻度肥胖（30≤体重指数<35kg/m²）和中重度肥胖（体重指数≥35kg/m²）分别与POAF风险增加1.4倍（95%CI：1.10至1.71；P=0.004）和2.3倍（95%CI：1.71至3.13；P<0.0001）独立相关。在年龄≤50岁的患者中，与POAF独立相关的是MS（相对风险[RR]：2.36；95%CI：1.10至5.12；P=0.02）而非肥胖。
本研究表明，肥胖是50岁以上患者单纯冠状动脉旁路移植术后发生POAF的一个重要危险因素。然而，在较年轻人群中未观察到这种关联，且MS是唯一与POAF独立相关的代谢危险因素。
