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Is SYNTAX Score Predictive of Atrial Fibrillation after On-Pump Coronary Artery Bypass Graft Surgery?

  • Cerit, Levent (Department of Cardiology, Near East University) ;
  • Duygu, Hamza (Department of Cardiology, Near East University) ;
  • Gulsen, Kamil (Department of Cardiology, Near East University) ;
  • Kemal, Hatice S (Department of Cardiology, Near East University) ;
  • Ozcem, Barcin (Department of Cardiovascular Surgery, Near East University) ;
  • Balcioglu, Ozlem (Department of Cardiovascular Surgery, Near East University) ;
  • Gunsel, Aziz (Department of Cardiology, Near East University) ;
  • Tosun, Ozgur (Department of Biostatistics, Near East University) ;
  • Emren, Volkan (Department of Cardiology, Afyon State Hospital)
  • Received : 2016.01.24
  • Accepted : 2016.03.15
  • Published : 2016.11.30

Abstract

Background and Objectives: The relationship of synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score and development of atrial fibrillation (AF) after coronary artery bypass surgery (CABG) has not been studied. Therefore, we assessed the relationship between the SYNTAX score and development of AF after CABG (POAF). Subjects and Methods: The medical records of consecutive patients, who underwent CABG surgery from January 2013 to September 2015, were retrospectively reviewed for the development of AF in the postoperative period. SYNTAX score, clinical and echocardiographic parameters were evaluated. The independent variables for the development of POAF were defined and their predictive values were measured. Results: The study group consisted of 106 patients, of which 36 (34%) developed POAF. Age, hypertension, stroke, chronic obstructive pulmonary disease (COPD), heart failure (HF), diabetes mellitus (DM), left atrial diameter, neutrophil/lymphocyte ratio, platelet large cell ratio, creatinine, blood urea nitrogen and SYNTAX score were identified as important variables for the development of POAF. However, in logistic regression analysis COPD (OR=19.313, 95% CI=2.416-154.407, p=0.005), HF (OR=28.362, 95% CI=2.034-395.515, p=0.013), SYNTAX score (OR=0.863, 95% CI=0.757-0.983, p=0.026), and DM (OR=20.770, 95% CI=3.791-113.799, p<0.001) appeared as independent variables predicting the development of POAF. In receiver operation characteristic analysis, SYNTAX score (${\geq}22.25$) (AUC=0.777, 95% CI=0.676-0.877, p<0.001) was one of the strongest predictors for the development of POAF. Conclusion: The SYNTAX score level was independently associated with the development of AF after CABG.

Keywords

References

  1. Blommaert D, Gonzalez M, Mucumbitsi J, et al. Effective prevention of atrial fibrillation by continuous atrial overdrive pacing after coronary artery bypass surgery. J Am Coll Cardiol 2000;35:1411-5. https://doi.org/10.1016/S0735-1097(00)00608-2
  2. Amar D, Shi W, Hogue CW Jr, et al. Clinical prediction rule for atrial fibrillation after coronary artery bypass grafting. J Am Coll Cardiol 2004;44:1248-53. https://doi.org/10.1016/j.jacc.2004.05.078
  3. American heart association heart disease and stroke statisticsupdate at-A-glance. Circulation 2007;115:69-171. https://doi.org/10.1161/CIRCULATIONAHA.106.179918
  4. Lip GY, Beevers DG. History, epidemiology and importance of atrial fibrillation. BMJ 1995;311:1361-3. https://doi.org/10.1136/bmj.311.7016.1361
  5. Kralev S, Schneider K, Lang S, Suselbeck T, Borggrefe M. Incidence and severity of coronary artery disease in patients with atrial fibrillation undergoing first-time coronary angiography. PLoS One 2011;6:e24964. https://doi.org/10.1371/journal.pone.0024964
  6. Van Gelder IC, Groenveld HF, Crijns HJ, et al. Race II Investigators. Lenient versus strict rate control in patients with atrial fibrillation. N Engl J Med 2010;362:1363-73. https://doi.org/10.1056/NEJMoa1001337
  7. Crijns HJ, Van Gelder IC, Van Gilst WH, Hillege H, Gosselink AM, Lie KI. Serial antiarrhythmic drug treatment to maintain sinus rhythm after electrical cardioversion for chronic atrial fibrillation or atrial flutter. Am J Cardiol 1991;68:335-41. https://doi.org/10.1016/0002-9149(91)90828-9
  8. AFFIRM Investigators. Atrial Fibrillation Follow-up Investigation of Rhythm Management. Baseline characteristics of patients with atrial fibrillation: the AFFIRM study. Am Heart J 2002;143:991-1001. https://doi.org/10.1067/mhj.2002.122875
  9. Sianos G, Morel MA, Kappetein AP, et al. The SYNTAX score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention 2005;1:219-27.
  10. Aksakal E, Tanboga IH, Kurt M. Predictors of coronary lesions complexity in patients with stable coronary artery disease. Angiology 2013;64:304-9. https://doi.org/10.1177/0003319712464815
  11. Ucar H, Gur M, Borekci A et al. Relationship between extent and complexity of coronary artery disease and different left ventricular geometric patterns in patients with coronary artery disease and hypertension. Anatol J Cardiol 2015;15;789-94. https://doi.org/10.5152/akd.2014.5747
  12. Benjamin EJ, Wolf PA, D'Agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 1998;98:946-52. https://doi.org/10.1161/01.CIR.98.10.946
  13. Banach M, Rysz J, Drozdz JA, et al. Risk factors of atrial fibrillation following coronary artery bypass grafting: a preliminary report. Circ J 2006;70:438-41. https://doi.org/10.1253/circj.70.438
  14. Sidney S, Sorel M, Quesenberry CP Jr, DeLuise C, Lanes S, Eisner MD. COPD and incident cardiovascular disease hospitalizations and mortality: Kaiser Permanente Medical Care Program. Chest 2005;128:2068-75. https://doi.org/10.1378/chest.128.4.2068
  15. Caglar IM, Dasli T, Turhan Caglar FN, Teber MK, Ugurlucan M, Ozmen G. Evaluation of atrial conduction features with tissue Doppler imaging in patients with chronic obstructive pulmonary disease. Clin Res Cardiol 2012;101:599-606. https://doi.org/10.1007/s00392-012-0431-7
  16. Benjamin EJ, Levy D, Vaziri SM, D'Agostino RB, Belanger AJ,Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort: The Framingham heart study. JAMA 1994;271:840-4. https://doi.org/10.1001/jama.1994.03510350050036
  17. Middlekauff HR, Stevenson WG, Stevenson LW. Prognostic significance of atrial fibrillation in advanced heart failure: A study of 390 patients. Circulation 1991;84:40-8. https://doi.org/10.1161/01.CIR.84.1.40
  18. Huxley RR, Filion KB, Konety S, Alonso A. Meta-analysis of cohort and case-control studies of type 2 diabetes mellitus and risk of atrial fibrillation. Am J Cardiol 2011;108:56-62. https://doi.org/10.1016/j.amjcard.2011.03.004
  19. Schoen T, Pradhan AD, Albert CM, Conen D. Type 2 diabetes mellitus and risk of atrial fibrillation in women. J Am Coll Cardiol 2012;60:1421-8. https://doi.org/10.1016/j.jacc.2012.06.030
  20. Rechciński T, Jasińska A, Foryś J, et al. Prognostic value of platelet indices after acute myocardial infarction treated with primary percutaneous coronary intervention. Cardiol J 2013;20:491-8. https://doi.org/10.5603/CJ.2013.0134
  21. Shao Q, Chen K, Rha SW, Lim HE, Li G, Liu T. Usefulness of Neutrophil/Lymphocyte Ratio as a Predictor of Atrial Fibrillation: A Meta-analysis. Arch Med Res 2015;46:199-206. https://doi.org/10.1016/j.arcmed.2015.03.011
  22. Kwon CH, Kim J, Kim MS, et al. Impact of Impaired Renal Function on the Incidence of Atrial Fibrillation following Radiofrequency Ablation of Cavotricuspid Isthmus-Dependent Atrial Flutter. Korean Circ J 2015;45:473-78. https://doi.org/10.4070/kcj.2015.45.6.473
  23. Valgimigli M, Serruys PW, Tsuchida K, et al. Cypher-ing the complexity of coronary artery disease using the SYNTAX score to predict clinical outcome in patients with three-vessel lumen obstruction undergoing percutaneous coronary intervention. Am J Cardiol 2007;99:1072-81. https://doi.org/10.1016/j.amjcard.2006.11.062
  24. Fukui T, Uchimuro T, Takanashi S. EuroSCORE II with SYNTAX score to assess risks of cor-onary artery bypass grafting outcomes. Eur J Cardiothorac Surg 2015;47:66-71. https://doi.org/10.1093/ejcts/ezu045
  25. Moller CH, Penninga L, Wetterslev J, Steinbruchel DA, Gluud C. Offpump versus on-pump coronary artery bypass grafting for ischaemic heart disease. Cochrane Database Syst Rev 2012;3:CD007224.

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