Association with Platelet Distribution Width and New-Onset Atrial Fibrillation After Coronary Artery Bypass Grafting

Objective: The platelet distribution width (PDW) is one of the parameters of platelet activation. The PDW directly measures the variability in platelet size. However, there has been a limited number of data reported thus far on PDW and postoperative AF in patients undergoing CABG. We aimed to investigate the relationship between the PDW and postoperative AF in patients undergoing CABG. Methods: 124 consecutive patients with sinus rhythm who had undergone CABG between July 2011 and December 2013 were evaluated. AF was defined as any episode of AF lasting longer than 30 seconds. Complete blood count samples were analyzed according to the results obtained within 48 hours of the preoperative and postoperative period. Results: The preoperative PDW levels were significantly lower in patients who had developed AF than in the control group (56.5±14.8 vs. 50.9±10.0, p=0.015). There was no correlation between the postoperative PDW levels and AF. The preoperative white blood cell (WBC) and the neutrophil/lymphocyte ratio (NLR) were found to be similar between the two groups, while the postoperative WBC (13.9±5.7 vs. 10.5±3.6, p=0.000) and NLR (14.4±9.4 vs. 9.0±8.4, p: 0. 001) levels were higher in the group of patients who had AF. An NLR of 8.5 predicted post-CABG AF with a sensitivity of 73% and a specificity of 63%, and a WBC of 10 predicted post-CABG AF with a sensitivity of 77% and a specificity of 48%. Conclusion: These results support the hypothesis that preoperative PDW level predicts new-onset AF after CABG, but suggest that other factors are also important

Koroner Arter Bypass Cerrahisi Sonrası Yeni Gelişen Atrial Fibrilasyon ile Platelet Distribution Width Arasındaki İlişki

Amaç: Platelet distribution width (PDW) trombosit aktivasyon parametrelerinden biridir. PDW trombosit büyüklüğündeki çeşitliliği direkt olarak ölçer. Bununla birlikte şimdiye kadar koroner arter bypass cerrahisi (CABG) yapılan hastalarda postoperatif AF ile PDW ilişkisini inceleyen sınırlı sayıda yayın bulunmaktadır. Biz CABG yapılan hastalarda PDW ile postoperatif AF arasındaki ilişkiyi incelemeyi planladık. Yöntemler: Haziran 2011 ile Aralık 2013 arasında CABG yapılan 124 ardışık hastayı değerlendirdik. AF, 30 sn den uzun süren AF atakları olarak tanımlanmıştır. Preoperatif ve postoperatif 48 saat içinde tam kan örnekleri incelendi. Bulgular: Preoperatif PDW değerleri AF grubunda kontrol grubuna göre anlamlı olarak daha düşük bulundu. Preoperatif beyaz kan hücresi (WBC) ve nötrofil lenfosit oranı (NLR) iki grup arasında benzer bulunurken, postoperatif WBC ve NLR değerleri AF’ si olan grupta daha yüksek tespit edildi. Postoperatif AF de NLR için 8,5 tahmin değerinin duyarlılığı %73, özgüllüğü %63 ve WBC için 10 tahmin değerinin duyarlılığı %77, özgüllüğü %48 tespit edildi. Sonuç: Bu sonuçlar yeni başlangıçlı postCABG AF de PDW değerinin öngördürücülüğü hipotezini desteklememektedir fakat diğer faktörlerin önemli olduğunu göstermektedir

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A Anselmi, G Possati, M Gaudino. Postoperative Inflammatory Reaction and Atrial Fibrillation: Simple Correlation or Causation?. Ann Thorac Surg 2009; 88: 326 –33.

Fontes ML, Amar D, Kulak A, et al. Increased preoperative white blood cell count predicts postoperative atrial fibrillation after coronary artery bypass surgery. J Cardiothorac Vasc Anesth. 2009 Aug; 23: 484-7. doi: 10.1053/j.jvca.2009.01.030

Lo B, Fijnheer R, Nierich AP, et al. C-reactive protein is a risk indicator for atrial fibrillation after myocardial revascularization. Ann Thorac Surg 2005; 79: 1530–5

Santimone I, Di Castelnuovo A, De Curtis A, et al. White blood cell count, sex and age are major determinants of heterogeneity of platelet indices in an adult general population: results from the MOLI-SANI project. Haematologica 2011; 96: 1180e8.

Beyan C, Kaptan K, Ifran A. Platelet count, mean platelet volume, platelet distribution width, and plateletcrit do not correlate with optical platelet aggregation responses in healthy volunteers. J Thromb Thrombolysis 2006; 22: 161e4.

D Calvo, B Delgado, S González, et al. Platelet distribution width is associated with 1-year all-cause mortality in the elderly population. Journal of Clinical Gerontology & Geriatrics 4 (2013) 12e16.

U Turk, I Tengiz, E Ozpelit, et al. The relationship between platelet indices and clinical features of coronary artery disease. Kardiologia Polska 2013; 71, 11: 1129–34; DOI: 10.5603/KP.2013.0293

Ihara A, Matsumoto K, Kawamoto T, et al. Evaluation of platelet indexes in patients with aortic aneurysm. Pathophysiol Haemost Thromb 2005; 34: 269e73.

M M Khandekar, A S Khurana, S D Deshmukh, et al. Platelet volume indices in patients with coronary artery disease and acute myocardial infarction: an Indian scenario. J Clin Pathol. 2006 February; 59: 146–9. doi: 10.1136/jcp.2004.025387

Sohara H, Amitani S, Kurose M, Miyahara K. Atrial fibrillation activates platelets and coagulation in a time-dependent manner: A study in patients with paroxysmal atrial fibrillation. J Am Coll Cardiol 1997; 29: 106–12

Boos CJ, Anderson RA, Lip GY. Is atrial fibrillation an inflammatory disorder? Eur Heart J 2006; 27: 136–49.

Gibson PH, Cuthbertson BH, Croal BL, et al. Usefulness of neutrophil/lymphocyte ratio as predictor of new-onset atrial fibrillation after coronary artery bypass grafting. Am J Cardiol. 2010 Jan 15; 105: 186-91. doi: 10.1016/j.amjcard.2009.09.007

Fontes ML, Amar D, Kulak A, et al. Increased preoperative white blood cell count predicts postoperative atrial fibrillation after coronary artery bypass surgery. J Cardiothorac Vasc Anesth. 2009 Aug; 23: 484-7. doi: 10.1053/j.jvca.2009.01.030

Köroğlu S, Tuncer C, Acar G, et al. Relation of inflammatory and oxidative markers to the occurrence and recurrence of persistent atrial fibrillation. Turk Kardiyol Dern Ars. 2012 Oct; 40 : 499-504. doi: 10.5543/tkda.2012.64160

Chung MK, Martin DO, Sprecher D, et al. C-reactive protein elevation in patients with atrial arrhythmias: inflammatory mechanisms and persistence of atrial fibrillation. Circulation 2001; 104: 2886–91.

Vagdatli E, Gounari E, Lazaridou E, et al. Platelet distribution width: a simple, practical and specific marker of activation of coagulation. Hippokratia 2010; 14: 28–32

M M Khandekar, A S Khurana, S D Deshmukh, et al. Platelet volume indices in patients with coronary artery disease and acute myocardial infarction: an Indian scenario. J Clin Pathol. 2006 February; 59: 146– 9. doi: 10.1136/jcp.2004.025387

Herve P, Humbert M, Sitbon O, et al. Pathobiology of pulmonary hypertension: the role of platelets and thrombosis. Clin Chest Med 22: 451–8.

De Luca G, Venegoni L, Iorio S, Secco GG, Cassetti E, Verdoia M, Schaffer A, Coppo L, Bellomo G, Marino P; Novara Atherosclerosis Study Group. Platelet distribution width and the extent of coronary artery disease: Results from a large prospective study. Platelets 2010; 21: 508-14

Choudhury A, Chung I, Blann AD, Lip GY. Platelet surface CD62P and CD63, mean platelet volume, and soluble/platelet P-selectin as indexes of platelet function in atrial fibrillation: a comparison of “healthy control subjects” and “disease control subjects” in sinüs rhythm. J Am Coll Cardiol 2007; 49: 1957–64.

Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: A link Between thrombosis and inflammation? Curr Pharm Des 2011; 17: 47–58.

Kollar A， Lick SD， Vasquez KN， Conti VR. Relationship of atrial fibrillation and stroke after coronary artery bypass graft surgery ： when is anticoagulation indicated? Ann Thorac Surg. 2006 Aug; 82: 515-23.

Zangrillo A ， Landoni G， Sparicio D， et al. Predictors of atrial fibrillation after offpump coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth. 2004 Dec; 18: 704-8.

Ahlsson A, Bodin L, Fengsrud E, Englund A: Patients with postoperative atrial fibrillation have a doubled cardiovascular mortality. Scand Cardiovasc J 2009; 12: 1-7.

Mathew JP, Fontes ML, Tudor IC, et al: A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA 2004; 291: 1720-9.