Alameddine Abdallah K, Visintainer Paul, Alimov Victor K, Rousou John A
Division of Cardiac Surgery, Baystate Medical Center, Springfield, Massachusetts.
J Card Surg. 2014 Sep;29(5):593-9. doi: 10.1111/jocs.12383. Epub 2014 Jun 25.
Red blood cell transfusion (Tx) induces a proinflammatory state. Inflammatory mediators are associated with an increased risk of postoperative atrial fibrillation (AF). Therefore, in this study we determined the association between AF and Tx after isolated coronary artery bypass graft surgery (CABG).
Between January 2008 and December 2010, a total of 879 patients underwent CABG. Of these, 815 (92.7%) had complete data extracted from our institution's Society of Thoracic Surgeons (STS) database. Predictors of AF development among four levels of Tx versus nontransfused patients were examined. Multivariable logistic regression and propensity score matching models were used.
The mean age was 65.8 years (±10.3), 77.4% were male, and 54.4% had an STS predicted risk score (mortality/morbidity) of ≥10%. A total of 564 (69.2%) had at least one unit of Tx. Adjusting for age, sex, time on pump, congestive heart failure, stroke, creatinine level (<1.5 mg per deciliter vs. ≥1.5), STS morbidity/mortality score, perioperative myocardial infarction (MI), cross-clamp time, medications, and hemoglobin level, the odds ratio (OR) of AF increased with increasing Tx (OR, 1.36; 95% confidence interval [CI], 1.11 to 1.68; p = 0.003). The odds of AF increased 61% with each increasing level of Tx (OR, 1.61; 95% CI, 1.15 to 2.26; p = 0.006, by propensity analysis).
Perioperative Tx may be associated with excess AF following CABG. This risk increases with increasing number of Tx.
红细胞输血（Tx）会引发促炎状态。炎症介质与术后房颤（AF）风险增加相关。因此，在本研究中，我们确定了孤立冠状动脉搭桥术（CABG）后房颤与输血之间的关联。
2008年1月至2010年12月期间，共有879例患者接受了CABG。其中，815例（92.7%）从我们机构的胸外科医师协会（STS）数据库中提取了完整数据。研究了四级输血患者与未输血患者中房颤发生的预测因素。使用了多变量逻辑回归和倾向评分匹配模型。
平均年龄为65.8岁（±10.3），77.4%为男性，54.4%的患者STS预测风险评分（死亡率/发病率）≥10%。共有564例（69.2%）患者至少接受了一个单位的输血。校正年龄、性别、体外循环时间、充血性心力衰竭、中风、肌酐水平（<1.5毫克/分升与≥1.5）、STS发病率/死亡率评分、围手术期心肌梗死（MI）、交叉夹闭时间、药物和血红蛋白水平后，房颤的比值比（OR）随输血增加而升高（OR，1.36；95%置信区间[CI]，1.11至1.68；p = 0.003）。通过倾向分析，每增加一级输血，房颤的几率增加61%（OR，1.61；95% CI，1.15至2.26；p = 0.006）。
围手术期输血可能与CABG术后房颤过多有关。这种风险随着输血量的增加而增加。
