Efird Jimmy T, Jindal Charulata, Kiser Andy C, Akhter Shahab A, Crane Patricia B, Kypson Alan P, Sverdlov Aaron L, Davies Stephen W, Kindell Linda C, Anderson Ethan J
1 Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
2 Department of Cardiovascular Sciences, Brody School of Medicine, Greenville, NC, USA.
J Int Med Res. 2018 Aug;46(8):3183-3194. doi: 10.1177/0300060518773934. Epub 2018 May 29.
Background Postoperative atrial fibrillation (POAF) is a frequent complication of coronary artery bypass graft (CABG) surgery. This arrhythmia occurs more frequently among patients who receive perioperative inotropic therapy (PINOT). Administration of nitrates with antiplatelet agents reduces the conversion rate of cyclic guanosine monophosphate to guanosine monophosphate. This process is associated with increased concentrations of free radicals, catecholamines, and blood plasma volume. We hypothesized that patients undergoing CABG surgery who receive PINOT may be more susceptible to POAF when nitrates are administered with antiplatelet agents. Methods Clinical records were examined from a prospectively maintained cohort of 4,124 patients undergoing primary isolated CABG surgery to identify POAF-associated factors. Results POAF risk was increased among patients receiving PINOT, and the greatest effect was observed when nitrates were administered with antiplatelet therapy. Adjustment for comorbidities did not substantively change the study results. Conclusions Administration of nitrates with certain antiplatelet agents was associated with an increased POAF risk among patients undergoing CABG surgery. Additional studies are needed to determine whether preventive strategies such as administration of antioxidants will reduce this risk.
术后心房颤动（POAF）是冠状动脉旁路移植术（CABG）常见的并发症。这种心律失常在接受围手术期正性肌力药物治疗（PINOT）的患者中更为常见。硝酸盐与抗血小板药物联合使用会降低环磷酸鸟苷向磷酸鸟苷的转化率。这一过程与自由基、儿茶酚胺浓度升高及血浆容量增加有关。我们推测，接受PINOT的CABG手术患者在硝酸盐与抗血小板药物联合使用时可能更易发生POAF。方法：对前瞻性纳入的4124例行初次单纯CABG手术患者的临床记录进行检查，以确定与POAF相关的因素。结果：接受PINOT的患者发生POAF的风险增加，硝酸盐与抗血小板治疗联合使用时影响最为显著。对合并症进行校正并未实质性改变研究结果。结论：在接受CABG手术的患者中，硝酸盐与某些抗血小板药物联合使用会增加POAF风险。需要进一步研究以确定诸如使用抗氧化剂等预防策略是否会降低这一风险。
