nach oben

Erschienen in:

05.09.2022 | Original articles

Relationship between platelet mass index and postoperative atrial fibrillation after elective coronary artery bypass surgery: a retrospective study

verfasst von: Ozge Guzelburc, MD, Ahmet Zengin, MD, Mehmet Baran Karatas, MD, Sevinc Bayer Erdogan, MD, Prof. Ayse Emre

Erschienen in: Herz | Ausgabe 4/2023

Einloggen, um Zugang zu erhalten

Abstract

Background

Atrial fibrillation (AF) is the most common complication after cardiac surgery. The pathogenesis of postoperative atrial fibrillation (POAF) is multifactorial and one of the known factors is inflammation. Platelet mass index (PMI) is an indicator of platelet activation and a better inflammatory marker than mean platelet volume (MPV). In this retrospective study, we investigated the relationship between POAF and PMI.

Methods

The study included 848 consecutive patients (655 male and 193 female) who had elective isolated coronary artery by-pass grafting (CABG) or combined CABG and valvular surgery. Platelet count and MPV were measured from preoperative blood samples to calculate PMI. Post-operative atrial fibrillation was defined as irregular and fibrillatory P waves occurring 48–96 h after cardiac surgery and lasting at least 30 s. The PMI values in patients who developed POAF were compared with those in patients who did not develop POAF.

Results

Patients who developed POAF had higher PMI values (2549.3 ± 1077.1) when compared with patients in sinus rhythm (2248.1 ± 683.4; p < 0.01). In multivariate regression analysis, age (OR: 1.05; 95% CI: 1.02–1.09; p = 0.01), left atrial diameter (OR: 1.05; 95% CI: 1.03–1.09; p = 0.02), hs-CRP (OR: 1.09; 95%CI: 1.05–1.13; p < 0.01), EuroSCORE II (OR: 1.27; 95% CI: 1.14–1.41; p < 0.01), and PMI (OR: 1.01; 95% CI: 1.001–1.02; p < 0.01) were independent predictors of POAF. In ROC analysis, PMI ≥ 2286 predicted POAF development with a sensitivity of 69% and a specificity of 58% (AUC: 0.66; p < 0.01)

Conclusion

A significant relationship was found between preoperatively calculated PMI and POAF. We showed that PMI may be used to predict patients who are at high risk of developing POAF.

Hogue CW, Hyder ML (2000) Atrial fibrillation after cardiac operation: risks, mechanisms, and treatment. Ann Thorac Surg 69(1):300–306CrossRefPubMed

Braunwald’s Heart Disease Review and Assessment. 11. edn, pp 730–744

Dobrev D, Aguilar M, Heijman J, Guichard JB, Nattel S (2019) Postoperative atrial fibrillation: mechanisms, manifestations and management. Nat Rev Cardiol 16(7):417–436CrossRefPubMed

Echahidi N, Pibarot P, O’Hara G, Mathieu P (2008) Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery. J Am Coll Cardiol 51(8):793–801. https://doi.org/10.1016/j.jacc.2007.10.043CrossRefPubMed

Elahi M, Hadjinikolaou L, Galiñanes M (2003) Incidence and clinical consequences of atrial fibrillation within 1 year of first-time isolated coronary bypass surgery. Circulation 108:II207–II212CrossRefPubMed

Mathew JP, Parks R, Savino JS et al (1996) Atrial fibrillation following coronary artery bypass graft surgery: predictors, outcomes, and resource utilization. MultiCenter Study of Perioperative Ischemia Research Group. JAMA 276:300–306CrossRefPubMed

Maesen B, Nijs J, Maessen J et al (2012) Post-operative atrial fibrillation: a maze of mechanisms. Europace 14:159–174CrossRefPubMed

Attaran S, Shaw M, Bond L et al (2011) Atrial fibrillation postcardiac surgery: a common but a morbid complication. Interact CardioVasc Thorac Surg 12:772–777CrossRefPubMed

Gillinov AM, Bagiella E, Moskowitz AJ, Raiten JM, Groh MA, Bowdish ME et al (2016) Rate control versus rhythm control for atrial fibrillation after cardiac surgery. N Engl J Med 374:1911–1921CrossRefPubMedPubMedCentral

10.

Demir N, Peker E, Ece İ, Ağengin K, Bulan KA, Tuncer O (2016) Is platelet mass a more significant indicator than platelet count of closure of patent ductus arteriosus? J Matern Fetal Neonatal Med 29(12):1915–1918PubMed

11.

Okur N, Buyuktiryaki M, Uras N, Oncel MY, Ertekin O, Canpolat FE et al (2016) Platelet mass index in very preterm infants: can it be used as a parameter for neonatal morbidities? J Matern Fetal Neonatal Med 29(19):3218–3222CrossRefPubMed

12.

Korkmaz L, Baştuğ O, Ozdemir A, Korkut S, Karaca C, Akin MA et al (2017) The efficacy of propranolol in retinopathy of prematurity and its correlation with the platelet mass index. Curr Eye Res 42(1):88–97CrossRefPubMed

13.

Frendl G, Sodickson AC, Chung MK et al (2014) 2014 AATS guidelines for the prevention and management of postoperative atrial fibrillation and flutter for thoracic surgical procedures. J Thorac Cardiovasc Surg 148:e153–e193CrossRefPubMedPubMedCentral

14.

Shen J, Lall S, Zheng V, Buckley P, Damiano RJ, Schuessler RB (2011) The persistent problem of new-onset postoperative atrial fibrillation: a single-institution experience over two decades. J Thorac Cardiovasc Surg 141(2):559–570. https://doi.org/10.1016/j.jtcvs.2010.03.011CrossRefPubMedPubMedCentral

15.

Mariscalco G, Engström KG (2008) Atrial fibrillation after cardiac surgery: Risk factors and their temporal relationship in prophylactic drug strategy decision. Int J Cardiol 129(3):354–362CrossRefPubMed

16.

Caputo M, Yeatman M, Narayan P, Marchetto G, Ascione R, Reeves B et al (2002) Effect of off-pump coronary surgery with right ventricular assist device on organ function and inflammatory response: a randomized controlled trial. Ann Thorac Surg 74(6):2088–2095. https://doi.org/10.1016/s0003-4975(02)04025-0CrossRefPubMed

17.

Nguyen BAV, Suleiman M‑S, Anderson JR, Evans PC, Fiorentino F, Reeves B et al (2014) Metabolic derangement and cardiac injury early after reperfusion following intermittent cross-clamp fibrillation in patients undergoing coronary artery bypass graft surgery using conventional or miniaturized cardiopulmonary bypass. Mol Cell Biochem 395(1–2):167–175. https://doi.org/10.1007/s11010-014-2122-3CrossRefPubMed

18.

Zakkar M, Ascione R, James AF, Angelini GD, Suleiman MS (2015) Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery. Pharmacol Ther 154:13–20. https://doi.org/10.1016/j.pharmthera.2015.06.009CrossRefPubMed

19.

Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D et al (2016) 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 37:2893–2962CrossRefPubMed

20.

Bruins P, te Velthius H, Yazdanbaksh AP, Jansen PG, van Hardevelt FW, de Beaumont EM et al (1997) Activation of the complement system during and after cardiopulmonary bypass surgery: postsurgery activation involves C‑reactive protein and is associated with postoperative arrhythmia. Circulation 96:3542–3548CrossRefPubMed

21.

Li JY, He Y, Ke HH, Jin Y, Jiang ZY, Zhong GQ (2017) Plasma oxidative stress and inflammatory biomarkers are associated with the sizes of the left atrium pulmonary vein in atrial fibrillation patients. Clin Cardiol 40:89–94CrossRefPubMedPubMedCentral

22.

Aviles RJ, Martin DO, Apperson-Hansen C, Houghtaling PL, Rautaharju P, Kronmal RA, Tracy RP, Van Wagoner DR, Psaty BM, Lauer MS, Chung MK (2003) Inflammation as a risk factor for atrial fibrillation. Circulation 108:3006–3010CrossRefPubMed

23.

Lo B, Fijnheer R, Nierich AP, Bruins P, Kalkman CJ (2005) C‑reactive protein is a risk indicator for atrial fibrillation after myocardial revascularization. Ann Thorac Surg 79:1530–1535CrossRefPubMed

24.

Kaireviciute D, Blann AD, Balakrishnan B, Lane DA, Patel JV, Uzdavinys G et al (2010) Characterisation and validity of inflammatory biomarkers in the prediction of post-operative atrial fibrillation in coronary artery disease patients. Thromb Haemost 104:122–127CrossRefPubMed

25.

Öztürk S, Öztürk İ, İlhan S, Özgür A (2015) The role of C‑reactive protein on detection of postoperative atrial fibrillation in cardiac surgery: a systematic review and meta-analysis. Turk J Thorac Cardiovasc Surg 2381:182–190CrossRef

26.

Goldstein RN, Ryu K, Khrestian C, van Wagoner DR, Waldo AL (2008) Prednisone prevents inducible atrial flutter in the canine sterile pericarditis model. J Cardiovasc Electrophysiol 19:74–81PubMed

27.

Kumagai K, Nakashima H, Saku K (2004) The HMG-CoA reductase inhibitor atorvastatin prevents atrial fibrillation by inhibiting inflammation in a canine sterile pericarditis model. Cardiovasc Res 62:105–111CrossRefPubMed

28.

Zhang Z, Zhang C, Wang H, Zhao J, Liu L, Lee J et al (2010) n‑3 polyunsaturated fatty acids prevents atrial fibrillation by inhibiting inflammation in a canine sterile pericarditis model. Int J Cardiol. https://doi.org/10.1016/j.ijcard.2010.08.024.8CrossRefPubMedPubMedCentral

29.

Xu XF, Jiang FL, Ou MJ, Zhang ZH (2015) The association between mean platelet volume and chronic atrial fibrillation and the presence of thrombotic events. Biomed Rep 3:388–394CrossRefPubMedPubMedCentral

30.

Weymann A, Ali-Hasan-Al-Saegh S, Popov AF (2018) Hematologic indices as presdictors of atrial fibrillation following isolated coronary artery bypass grafting, valvular surgery or combined procedures: A systematic review with meta-analysis. Kardiol Pol 76(1):107–118CrossRefPubMed

31.

Erdem K, Ayhan S, Ozturk S (2014) Usefulness of the mean platelet volume for predicting new-onset atrial fibrillation after isolated coronary artery bypass grafting. Platelets 25:23–26CrossRefPubMed

32.

Ozsin KK, Sanri US, Toktaş F, Yavuz S (2018) Relationship between red cell distribution width and mean platelet volume with new onset atrial fibrillation after off-pump coronary artery bypass grafting. Bratisl Med J 119(6):355–340CrossRef

33.

Chandrashekar V (2013) Plateletcrit as a screening tool for detection of platelet quantitative disorders. J Hematol 2(1):22–26

34.

Erdogan D, Tayyar S, Icli A et al (2012) Elevated mean platelet volume is associated with impaired coronary microvascular function in patients with idiopathic dilated cardiomyopathy. Platelets 23:177–183CrossRefPubMed

35.

O’Malley T, Langhorne P, Elton RA, Stewart C (1995) Platelet size in stroke patients. Stroke 26:995–999CrossRefPubMed

36.

Varol E, Uysal BA, Ozaydin M (2011) Platelet indices in patients with pulmonary arterial hypertension. Clin Appl Thromb Hemost 17:E171–E174CrossRefPubMed

37.

Tschoepe D, Roesen P, Esser J et al (1991) Large platelets circulate in an activated state in diabetes mellitus. Semin Thromb Hemost 17:433–443CrossRefPubMed

38.

Keskin M, Kaya A, İpek G, Bolca O, Doğan S, Ozcelik F, Orhan AL (2020) A simple independent predictor of in-hospital and long-term outcomes in patients with STEMI: plateletcrit. Hamidiye Med J 1:22–28. https://doi.org/10.4274/hamidiyemedj.galenos.2020.65375CrossRef

39.

Akpinar I, Sayin MR, Gursoy YC, Karabag T, Kucuk E, Buyukuysal MC et al (2014) Plateletcrit: a platelet marker associated with saphenous vein graft disease. Herz 39:142–148CrossRefPubMed

40.

Oylumlu M, Yuksel M, Dogan A, Cakici M, Ozgeyik M, Yildiz A, Kilit C, Amasyali B (2015) The usefulness of plateletcrit to predict cardiac syndrome X in patients with normal coronary angiogram. Postepy Kardiol Interwencyjnej 11(3):197–201. https://doi.org/10.5114/pwki.2015.54013CrossRefPubMedPubMedCentral

41.

Akpinar I, Sayin MR, Gursoy YC, Aktop Z, Karabag T, Kucuk E et al (2014) Plateletcrit and red cell distribution width are independent predictors of the slow coronary flow phenomenon. J Cardiol 63:112–118CrossRefPubMed

42.

Helgadottir S, Sigurdsson MI, Ingvarsdottir IL, Arnar DO, Gudbjartsson T (2012) Atrial fibrillation following cardiac surgery: risk analysis and long-term survival. J Cardiothorac Surg 19(7):87CrossRef

43.

Lahtinen J, Biancari F, Salmela E, Mosorin M, Satta J, Rainio P et al (2004) Postoperative atrial fibrillation is a major cause of stroke after on-pump coronary artery bypass surgery. Ann Thorac Surg 77(4):1241–1244CrossRefPubMed

44.

Ghurram A, Krishna N, Bhaskaran R, Kumaraswamy N, Jayant A, Varma PK (2020) Patients who develop post-operative atrial fibrillation have reduced survival after off-pump coronary artery bypass grafting. Indian J Thorac Cardiovasc Surg 36(1):6–13. https://doi.org/10.1007/s12055-019-00844-9CrossRefPubMed

45.

Vlahou A, Diplaris K, Ampatzidou F, Karagounnis L, Drossos G (2016) The role of blood transfusion in the development of atrial fibrillation after coronary artery bypass grafting. Thorac Cardiovasc Surg 64(8):688–692. https://doi.org/10.1055/s-0036-1587699CrossRefPubMed

46.

Dogan A, Gunesdogdu F, Sever K, Kahraman S, Mansuroglu D, Yolcu M, Ozdemir E, Kurtoglu N (2019) Atrial fibrillation prediction by surgical risk scores following isolated coronary artery bypass grafting surgery. J Coll Physicians Surg Pak 29(11):1038–1042. https://doi.org/10.29271/jcpsp.2019.11.1038CrossRefPubMed

47.

Ozturk S, Kalyoncuoglu M, Sahin M (2019) Comparison of SYNTAX score I and SYNTAX score II for predicting postoperative atrial fibrillation in patients undergoing coronary artery bypass graft surgery. Heart Surg Forum 22(5):E319–E324. https://doi.org/10.1532/hsf.2495CrossRefPubMed

48.

Luo W, Huaibin W, Wenjun Z, Jie T, Xiaokang O, Zi W, Yujian M (2017) Predictors of postoperative atrial fibrillation after isolated on-pump coronary artery bypass grafting in patients ≥60 years old. Heart Surg Forum 20(1):E38–E42. https://doi.org/10.1532/hsf.1583CrossRefPubMed

49.

Vallurupalli S, Shanbhag A, Mehta JL (2017) Controversies in postoperative atrial fibrillation after noncardiothoracic surgery: clinical and research implications. Clin Cardiol 40(5):329–332CrossRefPubMedPubMedCentral

50.

Greenberg JW, Lancaster TS, Schuessler RB, Melby SJ (2017) Postoperative atrial fibrillation following cardiac surgery: a persistent complication. Eur J Cardiothorac Surg 52(4):665–672CrossRefPubMed

51.

Al-Khatib SM, Arshad A, Balk EM et al (2016) Risk stratification for arrhythmic events in patients with asymptomatic pre-excitation: a systematic review for the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the heart rhythm society. J Am Coll Cardiol 67:1624–1638CrossRefPubMed

Titel: Relationship between platelet mass index and postoperative atrial fibrillation after elective coronary artery bypass surgery: a retrospective study
verfasst von: Ozge Guzelburc, MD
Ahmet Zengin, MD
Mehmet Baran Karatas, MD
Sevinc Bayer Erdogan, MD
Prof. Ayse Emre
Publikationsdatum: 05.09.2022
Verlag: Springer Medizin
Erschienen in: Herz / Ausgabe 4/2023
Print ISSN: 0340-9937
Elektronische ISSN: 1615-6692
DOI: https://doi.org/10.1007/s00059-022-05136-4

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Relationship between platelet mass index and postoperative atrial fibrillation after elective coronary artery bypass surgery: a retrospective study