[Epidemiology and new predictors of atrial fibrillation after coronary surgery]. / Epidemiología y nuevos predictores de la fibrilación auricular tras cirugía coronaria.

INTRODUCTION AND OBJECTIVES: Postoperative atrial fibrillation (PAF) is a frequent complication of coronary artery bypass grafting (CABG). Our aims were to study its epidemiology and to identify predictors in everyday clinical practice, while taking into account statin use, extracorporeal circulation, and new biomarkers of inflammation and ventricular stress. METHODS: The study included 102 consecutive patients (65 [9] years, 72% male) who were undergoing CABG. Blood samples were taken the day before surgery to determine baseline levels of C-reactive protein (CRP) and N-terminal probrain natriuretic peptide (NT-proBNP). Details of baseline clinical characteristics, preoperative treatment and surgery were recorded. The end-point was PAF at 30 days. RESULTS: The incidence of PAF was 23% (n=23; 3.2 [2.9] days, range 1-15 days). Its appearance was associated with a longer stay in the intensive care unit (+ 1 day; P=.019), but not with an increased total hospital stay (P=.213). Among patients with PAF, 4.3% had an embolism and 8.6% remained in atrial fibrillation at discharge. Moreover, PAF was associated with a longer duration of ischemia (28.5 [22.3] vs 18.0 [27.9]; P=.045) and a lower statin pretreatment rate (39% vs 66%; P=.022). Multivariate analysis showed that the only factor associated with a higher risk of PAF was the absence of statin pretreatment (odds ratio = 4.31, 95% confidence interval 1.33-13.88; P=.015). There was no association between either extracorporeal circulation or the baseline CRP or NT-proBNP level and an increased risk of PAF. CONCLUSION: In everyday clinical practice, PAF is a frequent complication. Statin pretreatment could have a protective effect against its appearance.

Epidemiología y nuevos predictores de la fibrilación auricular tras cirugía coronaria / Epidemiology and new predictors of atrial fibrillation after coronary surgery

Introducción y objetivos. La fibrilación auricular postoperatoria (FAP) es una complicación frecuente tras la cirugía de revascularización coronaria. Estudiamos su epidemiología y los predictores en la práctica actual, considerando el uso de estatinas, la circulación extracorpórea y los nuevos biomarcadores de inflamación y estrés ventricular. Métodos. Se estudió a 102 pacientes consecutivos (65 ± 9 años, 72% varones) en los que se realizó cirugía coronaria. El día previo se obtuvieron las muestras plasmáticas para medida de proteína C reactiva (PCR) y porción amino-terminal del propéptido natriurético cerebral (NT-proBNP), se recogieron las características clínicas basales y el tratamiento preoperatorio, posteriormente se registraron los datos quirúrgicos y se estudió la aparición de FAP a 30 días. Resultados. La incidencia de FAP fue del 23% (n = 23) (3,2 ± 2,9 días; intervalo, 1-15 días). Su aparición prolongó los cuidados intensivos (mediana + un día; p = 0,019) pero no la estancia hospitalaria total (p = 0,213). Entre los pacientes con FAP, los embolismos y la persistencia en FA en el momento del alta fueron del 4,3 y el 8,6%, respectivamente. La FAP se asoció con un mayor tiempo de isquemia (28,5 ± 22,30 frente a 18,0 ± 27,9 min; p = 0,045) y una menor tasa de estatinas preoperatorias (el 39 frente al 66%; p = 0,022). En el análisis multivariable, sólo la ausencia de estatinas conllevó un mayor riesgo de FAP (odds ratio [OR] = 4,31; intervalo de confianza [IC] del 95%, 1,33-13,88; p = 0,015). El uso de circulación extracorpórea (CEC) y los valores basales de PCR y NT-proBNP no se asociaron con un mayor riesgo. Conclusión. En la práctica actual, la FAP es una complicación frecuente y la administración de estatinas en el preoperatorio podría proteger frente a su aparición (AU)

Introduction and objectives. Postoperative atrial fibrillation (PAF) is a frequent complication of coronary artery bypass grafting (CABG). Our aims were to study its epidemiology and to identify predictors in everyday clinical practice, while taking into account statin use, extracorporeal circulation, and new biomarkers of inflammation and ventricular stress. Methods. The study included 102 consecutive patients (65 [9] years, 72% male) who were undergoing CABG. Blood samples were taken the day before surgery to determine baseline levels of C-reactive protein (CRP) and N-terminal probrain natriuretic peptide (NT-proBNP). Details of baseline clinical characteristics, preoperative treatment and surgery were recorded. The end-point was PAF at 30 days. Results. The incidence of PAF was 23% (n=23; 3.2 [2.9] days, range 1-15 days). Its appearance was associated with a longer stay in the intensive care unit (+ 1 day; P=.019), but not with an increased total hospital stay (P=.213). Among patients with PAF, 4.3% had an embolism and 8.6% remained in atrial fibrillation at discharge. Moreover, PAF was associated with a longer duration of ischemia (28.5 [22.3] vs 18.0 [27.9]; P=.045) and a lower statin pretreatment rate (39% vs 66%; P=.022). Multivariate analysis showed that the only factor associated with a higher risk of PAF was the absence of statin pretreatment (odds ratio = 4.31, 95% confidence interval 1.33­13.88; P=.015). There was no association between either extracorporeal circulation or the baseline CRP or NT-proBNP level and an increased risk of PAF. Conclusion. In everyday clinical practice, PAF is a frequent complication. Statin pretreatment could have a protective effect against its appearance (AU)