Melbourne Medical School, The University of Melbourne, Melbourne, Australia; Department of Cardiology, St Vincent's Hospital, Melbourne, Australia.
Department of Cardiology, St Vincent's Hospital, Melbourne, Australia.
Ann Thorac Surg. 2020 Oct;110(4):1265-1270. doi: 10.1016/j.athoracsur.2020.02.008. Epub 2020 Mar 10.
Postoperative atrial fibrillation (POAF) is a common complication after coronary artery bypass grafting (CABG) and is associated with increased short-term and long-term mortality. While the precise etiology of POAF remains unclear, inflammation is a known contributing factor. Preliminary studies have suggested that an elevated preoperative platelet-to-lymphocyte ratio (PLR), an inexpensive and readily available novel inflammatory biomarker, may be associated with increased incidence of POAF after CABG. This study sought to further investigate this hypothesis.
The study cohort included all patients undergoing isolated CABG, with no prior history of arrhythmia, who were operated on between August 1, 2010, and December 31, 2018, at a major Australian tertiary center (n = 1457). Patients were divided into low (<86) or high (≥86) PLR groups based on an optimal cutoff derived from receiver-operating characteristic curve analysis. The incidence of POAF was then compared. Categorical variables were analyzed using the chi-square test and continuous variables using logistic regression.
Of 1457 patients, 495 (34.0%) developed POAF. There was no statistically significant difference in the incidence of POAF between patients in the high-PLR and low-PLR groups (34.8% vs 31.0%; P = .22). Using multivariable logistic regression analysis, high PLR was not independently associated with POAF (odds ratio, 1.04; P = .78).
Elevated preoperative PLR is not independently associated with POAF in patients undergoing isolated CABG. The findings of this study differ from those of 2 previous smaller studies.
术后心房颤动（POAF）是冠状动脉旁路移植术（CABG）后的常见并发症，与短期和长期死亡率增加有关。虽然 POAF 的确切病因尚不清楚，但炎症是已知的促成因素。初步研究表明，术前血小板与淋巴细胞比值（PLR）升高，一种廉价且易于获得的新型炎症生物标志物，可能与 CABG 后 POAF 的发生率增加有关。本研究旨在进一步探讨这一假设。
研究队列包括所有在澳大利亚一家主要的三级中心接受单纯 CABG 手术、无心律失常病史、于 2010 年 8 月 1 日至 2018 年 12 月 31 日期间接受手术的患者（n=1457）。根据受试者工作特征曲线分析得出的最佳截断值，将患者分为低（<86）或高（≥86）PLR 组。然后比较 POAF 的发生率。使用卡方检验分析分类变量，使用逻辑回归分析连续变量。
在 1457 例患者中，有 495 例（34.0%）发生 POAF。高 PLR 组和低 PLR 组 POAF 的发生率无统计学差异（34.8% vs. 31.0%；P=0.22）。多变量逻辑回归分析显示，高 PLR 与 POAF 无关（比值比，1.04；P=0.78）。
在接受单纯 CABG 的患者中，术前 PLR 升高与 POAF 无关。本研究的结果与之前两项较小的研究不同。
