ABSTRACT
OBJECTIVE@#To study the relationship between preoperative plasma interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), homocysteine (Hcy), endothelin-1 (ET-1) levels and new-onset atrial fibrillation (AF) after coronary artery bypass grafting (CABG).@*METHODS@#In the study, 148 patients who underwent isolated CABG in Peking University People's Hospital from January 1, 2017 to December 30, 2017 were enrolled, of whom 39 had new-onset AF. The fasting venous blood was collected within 24 hours before the surgery. The preoperative plasma IL-1, IL-6, TNF-α, Hcy, ET-1 levels were detected by enzyme-linked immunosorbent assay (ELISA). The patients were divided into AF group and non-AF group according to whether new-onset AF occurred after operation. After 1 ∶1 propensity score matching (PSM), 38 people were in each group. The paired sample t-tests were performed on the five factors' concentrations of the matched AF group and the non-AF group respectively. If the concentration values did not conform to the normal distribution, the Wilcoxon signed rank sum test was performed. Conditional Logistic regression analysis was performed on the concentrations of the five indicators to explore the correlation between preoperative plasma concentrations of IL-1, IL-6, TNF-α, Hcy, ET-1 and postoperative new-onset AF after CABG.@*RESULTS@#After a 1 ∶1 propensity score matching, the AF group was comparable to the non-AF group. The concentrations of IL-1, IL-6, TNF-α, and Hcy in the AF group were higher than those in the non-AF group[(0.867±0.589) ng/L vs. (0.742±0.262) ng/L, 21.55 (6.50, 209.90) ng/L vs. 17.95 (3.60, 86.70) ng/L, 20.30 (5.70, 361.00) ng/L vs. 21.50 (7.50, 251.80) ng/L, (0.29±0.11) μmol/L vs. (0.27±0.09) μmol/L], but the differences were not statistically significant (P=0.165, P=0.891, P=0.817, P=0.285). After the conditional Logistic regression analysis, the above four variables were not predictors of new-onset AF after CABG. The concentrations of ET-1 in the matched AF group and non-AF group were (25.80±6.20) ng/L and (29.10±8.54) ng/L, respectively. The correlation between preoperative low plasma ET-1 concentration and the new-onset AF after CABG were statistically significant (P=0.003). After conditional Logistic regression analysis, preoperative plasma ET-1 concentration was correlated with postoperative new-onset AF after CABG (P=0.039, adjusted OR=0.637, 95%CI: 0.415-0.977).@*CONCLUSION@#The levels of preoperative plasma IL-1, IL-6, TNF-α and Hcy in the patients with new-onset AF after CABG were higher than those in the patients without AF, but the difference was not statistically significant. Preoperative plasma low ET-1 concentration was statistically associated with new-onset AF after CABG.
Subject(s)
Humans , Atrial Fibrillation/etiology , Coronary Artery Bypass , Propensity ScoreABSTRACT
Objectives:To describe the early and long-term survival of off-pump coronary artery bypass grafting(OPCAB)and to analyze the impact and risk factors of peri-operative events on mortality and long-term survival in OPCAB patients aged over 75 years old. Methods:From January 2001 to December 2012,233 patients aged over 75 underwent OPCAB in our hospital, 173 cases (74.25%) were male,the average age was (77.1±2.3) years.The perioperative data was retrospectively collected.Binary Logistic regression was used to define the risk factors related to the perioperative events and mortality.Follow-up was performed regularly post-surgery. Univariate analysis and Cox regression model were used to find out factors affecting the long-term outcomes. Results:Fifteen out of 233 patients died during the perioperative period. Binary Logistic regression showed that preoperative arrhythmia (OR=6.767, P=0.002),IABP ( intraoperative, post-operative) (OR=4.292, P=0.040;OR=19.455, P＜0.001), ICU stay time (OR=1.500, P=0.001), mechanical ventilation time (OR=1.004, P=0.002), reintubation or tracheotomy (OR=30.000, P＜0.001), re-thoracotomy (OR=26.750, P＜0.001), postoperative cerebral infarction (OR=5.889, P=0.041) were risk factors of perioperative mortality. The remaining 218 patients were followed up for a mean of (92.84±45.52) months, 121 patients died during follow-up. The survival rate at l, 3, 5, 8 and 10 years was 90.99%, 87.55%, 85.31%, 68.93% and 56.70%, respectively. Univariate analysis showed that sex(male), hypertension, preoperative arrhythmia, reintubation or tracheotomy were risk factors of the long-term mortality (P＜0.05). Cox regression analysis showed that reintubation or tracheotomy (HR 4.387, 95%CI=1.876-10.259,P＜0.010) was the independent risk factor affecting the long-term survival. Conclusions:Preoperative arrhythmia, IABP (intraoperative, postoperative), ICU stay time, mechanical ventilation time, reintubation and tracheotomy, re-thoracotomy, postoperative cerebral infarction are risk factors of perioperative mortality. Reintubation or tracheotomy is the independent risk factor affecting the long-term survival.Taken together, OPCAB in patients aged over 75 is associated with favorable perioperative and long-term outcome,and it serves a safe and effective operative strategy for coronary artery revascularization in patients aged over 75.