High preoperative monocyte count/high-density lipoprotein ratio is associated with postoperative atrial fibrillation and mortality in coronary artery bypass grafting.

Objectives: The monocyte to high-density lipoprotein ratio has recently emerged as an indicator of inflammation and oxidative stress. The aim of this study was to evaluate the association of the monocyte to high-density lipoprotein ratio with postoperative atrial fibrillation and mortality in coronary artery bypass grafting. Methods: Six hundred and sixty-two patients who were in sinus rhythm preoperatively and who had isolated coronary artery bypass grafting were retrospectively included in the study. Patients who had atrial fibrillation in the early postoperative period were enrolled in group 1 ( n = 153); patients who remained in sinus rhythm in the early postoperative period were included in group 2 ( n = 509). The clinical and demographic data of the patients, biochemical and complete blood count parameters, preoperative monocyte count/high-density lipoprotein cholesterol ratio, and operative and postoperative data were recorded. Results: Preoperative monocyte counts ( P = 0.0001), monocyte count/high-density lipoprotein cholesterol ratio ( P = 0.0001) and C-reactive protein levels ( P = 0.0001) were significantly increased in group 1. In the first month, 8 patients in group 1 (5.2%) and 5 patients in group 2 (1.0%) died, which was statistically significant ( P = 0.003). In univariate and multivariate logistic regression analyses, an elevated preoperative monocyte count/high-density lipoprotein cholesterol ratio ( P = 0.03) and C-reactive protein levels ( P = 0.0001) were predictors of postoperative atrial fibrillation. Preoperative monocyte counts ( P = 0.001), monocyte count/high-density lipoprotein cholesterol ratio ( P = 0.0001) and the use of inotropic support ( P = 0.0001) were also predictors of mortality in the early postoperative period. Conclusions: We have observed that high preoperative monocyte count/ high-density lipoprotein ratio was associated with postoperative atrial fibrillation and mortality after coronary artery bypass grafting operation.

Anaphylactic shock associated with intravenous amiodarone.

A 64-year-old woman was admitted to our emergency department with shortness of breath and palpitation which started 2 h before her admission. She had a history of rheumatic mitral valve disease and was on drug treatment with warfarin and metoprolol. The patient was orthopneic, blood pressure was 108/68 mmHg with an irregular pulse with a heart rate of 158 beats per minute, and respiratory rate was 23 times per minute. Her electrocardiogram was consistent with atrial fibrillation with rapid ventricular response. For pharmacological cardioversion the patient was given amiodarone intravenous loading dose of 300 mg in 30 min. After 10 min of infusion the patient complained of pruritus and skin rash consistent with urticaria. At the same time the patient had dyspnea and bronchoconstriction was noted on both lung fields. The blood pressure was measured as 64/40 mmHg. The patient was taken to intensive care unit and supportive treatment for anaphylactic shock was given. Amiodarone is a class III antiarrhythmic agent frequently used in the management of atrial fibrillation. This potentially fatal complication of amiodarone should be kept in mind by clinicians and before administration patients should be questioned about previous allergic reactions including previous iodine or iodinated contrast media. Alternative agents should be considered in these conditions. .