Jiang Qin, Huang Keli, Lin Shanshan, Wang Deliang, Tang Zhiai, Hu Shengshou
Department of Cardiac Surgery, Sichuan Provincial People's Hospital; Affiliated hospital of University of Electronic Science and Technology, Chengdu, China.
Department of Cardiac Surgery, Sichuan Provincial People's Hospital; Affiliated hospital of University of Electronic Science and Technology, Chengdu, China.
Am J Cardiol. 2025 Jan 1;234:30-37. doi: 10.1016/j.amjcard.2024.10.004. Epub 2024 Oct 22.
The effect of multiarterial (MA) versus single arterial (SA) coronary bypass graft surgery on postoperative atrial fibrillation (POAF) was not investigated. From May 2017 to May 2024, the patients with CYP2C19*2 or *3 allele receiving coronary artery grafting and postoperational aspirin 100 mg/day and clopidogrel 75 mg/day were retrospectively reviewed and assigned to the MA or SA group. The primary end point was the incidence rate of POAF in the first week. The secondary end points were POAF burden, platelet aggregation, systemic immune-inflammation index, and heart rate variability. The study included 58 cases in the MA group and 174 cases in the SA group. The incidence of POAF was 17% in the MA group, contrasting with 42% in the SA group (hazard ratio 0.353, 95% confidence interval 0.218 to 0.569, p = 0.0012). A lower POAF burden was observed in the MA group than in SA group (2 [1 to 5] vs 10 hours [6 to 20], p = 0.02). Platelet aggregation (arachidonic acid: 46 ± 10% vs 56 ± 8%, p <0.01; adenosine diphosphate: 58 ± 17% vs 75 ± 13%, p <0.01) and inflammation response index (neutrophil to lymphocyte ratio: 26 ± 4 vs 28 ± 5, p = 0.006; systemic immune-inflammation index: 5,019 ± 771 vs 5,382 ± 1,204, p = 0.032) was notably lower in MA group than those in SA group at 1 day after coronary artery bypass grafting. Holter electrocardiogram showed a higher heart rate variability value in the SD of the normal-to-normal RR intervals and decreased low frequency/high frequency ratio in the MA group. In conclusion, MA was associated with a lower incidence rate of POAF and paralleled with a lower atrial fibrillation burden, platelet aggregation, and inflammation reaction and a higher parasympathetic nerve tone than the SA regimen.
多支冠状动脉（MA）搭桥术与单支冠状动脉（SA）搭桥术对术后房颤（POAF）的影响尚未得到研究。2017年5月至2024年5月，对携带CYP2C192或3等位基因且接受冠状动脉搭桥术并术后服用每日100毫克阿司匹林和75毫克氯吡格雷的患者进行回顾性分析，并将其分为MA组或SA组。主要终点是第一周内POAF的发生率。次要终点是POAF负荷、血小板聚集、全身免疫炎症指数和心率变异性。该研究纳入MA组58例患者和SA组174例患者。MA组POAF发生率为17%，而SA组为42%（风险比0.353，95%置信区间0.218至0.569，p = 0.0012）。观察到MA组的POAF负荷低于SA组（2[1至5]小时对10小时[6至20]，p = 0.02）。冠状动脉搭桥术后1天，MA组的血小板聚集（花生四烯酸：46±10%对56±8%，p<0.01；二磷酸腺苷：58±17%对75±13%，p<0.01）和炎症反应指数（中性粒细胞与淋巴细胞比值：26±4对28±5，p = 0.006；全身免疫炎症指数：5019±771对5382±1204，p = 0.032）明显低于SA组。动态心电图显示，MA组正常RR间期标准差的心率变异性值较高，低频/高频比值降低。总之，与SA方案相比，MA与较低的POAF发生率相关，同时伴有较低的房颤负荷、血小板聚集和炎症反应，以及较高的副交感神经张力。
