Hülya SUNGURTEKİN, Vefa ÖZCAN, Fahri ADALI, Derviş VERDİ, Özgür KALKANCI, Ahmet BALTALARLI, İbrahim GÖKŞİN, Mustafa SAÇAR

Determinants of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting: prophylactic beta-blocker plus statin therapy for prevention of postoperative atrial fibrillation

Amaç: Bu çalışmada koroner arter bypass greftleme (KABG) sonrası atriyal fibrilasyon (AF) insidansı ve belirleyicileri ile β-bloker ve statin kullanımının AF oluşumu üzerine etkinliğinin araştırılması amaçlandı.Çalışma planı: Eylül 2003 ve Nisan 2004 tarihleri arasında ardışık olarak KABG cerrahisi uygulanan 121 hasta (99 kadın, 22 erkek; ort. yaş 61.2±7.5; dağılım 39-78) çalışmaya alındı. Hastalar, KABG sonrası AF varlığı [grup-AF, n=29] ya da yokluğuna [grup-SR (sinus), n=92] göre iki gruba ayrıldı. Değişkenler, Fischer’s exact test, chi-square ve independent samples t-test ile kıyaslandı. Koroner arter bypass greftleme sonrası AF’nin bağımsız belirleyicilerini saptamak için multivaryans lojistik regresyon analizi yapıldı.Bulgular: Hastaların %23.9’unda KABG sonrası AF saptandı. Ortalama yaş (66.6±7.2 ve 59.4±7.9, p=0.0001) ve kronik obstrüktif akciğer hastalığı insidansı (%13.8 ve %2.2, p=0.012) grup-AF’de daha yüksekti. Altmış üç yaşından daha büyük olan hastalarda KABG sonrası AF anlamlı olarak daha yüksek prevalansa sahipti (%41.3 ve %13.3, p=0.0001, ROC eğrisi altında kalan alan = 0.748). β-bloker kullanmayan hastalarda AF sıklığı daha fazlaydı (%40 ve %19.8, p=0.035). Statin alan hastalarda AF, almayan hastalara oranla daha düşük oranlardaydı (%15.9 ve %34.6, p=0.017). β-bloker ve statini birlikte alan hastalarda, bu iki ilacı da almayan hastalara göre AF oldukça düşük oranda saptandı (%13.3 ve %43.8, p=0.015). Statin alan hastalarda, statin almayan hastalara oranla ameliyat sonrası ikinci gündeki lökosit sayısı (10618±3540 ve 13038±5661, p=0.005) daha düşüktü. Mediastinal drenaj (1048.6±776.2 ve 641.5±514.6, p=0.001), ameliyat sonrası ikinci gündeki lökosit sayısı (13210±5550 ve 11160±4320, p=0.041) ve serum BUN (33.8±32.5 ve 21.6±13, p=0.004) değerleri grup-AF’de daha yüksekti. Yoğun bakımda (69.8±47.1 saat ve 53.6±19.2 saat, p=0.008) ve hastanede kalış süresi (LOS >7 gün, %58.6 ve %37, p=0.039) grup-AF’de anlamlı olarak daha yüksek bulundu. İleri yaş (OR=1.099, p=0.018) ve ameliyat sonrası drenaj miktarı (OR=1.001, p=0.045) KABG sonrası AF için bağımsız belirleyiciler olarak saptandı.Sonuç: Yaş ve ameliyat sonrası drenaj KABG sonrası AF için bağımsız belirleyicilerdir. β-bloker ve statinin birlikte kullanılması AF insidansını azaltan en iyi tedavi seçeneği gibi görünmektedir. Ancak, bu kombinasyon tedavisinin etkinliğini araştıran yeni prospektif çalışmalara ihtiyaç vardır.

Koroner bypass cerrahisi uygulanan hastalarda ameliyat sonrası atriyal fibrilasyonun belirleyicileri: Ameliyat sonrası atriyal fibrilasyonun önlenmesinde profilaktik beta-bloker ve statin tedavisi

Background: The aim of this study was to determine the incidence and predictors of post-coronary artery bypass grafting (CABG) atrial fibrillation (AF) and also, to investigate the effect of β-blocker plus statin use on post-CABG AF.Methods: Between September 2003 and April 2004, 121 consecutive patients (99 males, 22 females; mean age 61.2±7.5 years; range 39 to 78 years) undergoing elective CABG surgery were included to the study. The patients were divided into two groups according to the absence [group-SR (sinus ryhtym), n=92] or presence [group-AF, n=29] of post- CABG AF. Variables were compared by Fischer’s exact test, chi-square and independent samples t-test. Multivariate logistic regression analysis was used for independent predictors of post-CABG AF.Results: Post-CABG AF was detected in 23.9%. Mean age (66.6±7.2 vs 59.4±7.9, p=0.0001) and the incidence of chronic obstructive pulmonary disease (13.8 vs 2.2%, p=0.012) were higher in group-AF. The patient is older than 63 years of age (41.3 vs 13.3%, p=0.0001, area under the ROC curve of 0.748) have an increased prevalance of post-CABG AF. Much more frequent occurrence of post-CABG AF was in the patients without using β-blocker drug (40% vs 19.8%, p=0.035). Post-CABG AF was lower in the patients receiving statin than the patients not receiving statin (15.9% vs 34.6%, p=0.017). Post-CABG AF was lower in the patients receiving β-blocker plus statin therapy (13.3 vs 43.8%, p=0.015) than the patients not receiving these drugs. White blood cell (WBC) count of the patients receiving statin were lower than the patients not receiving statin (10618±3540 vs 13038±5661, p=0.005) in postoperative day 2 (POD 2). Chest tube drainage (1048.6±776.2 vs 641.5±514.6, p=0.001), and WBC count (13210±5550 vs 11160±4320, p=0.041), serum BUN (33.8±32.5 vs 21.6±13, p=0.004) in POD 2 were higher in group-AF. Intensive care unit stay (69.8±47.1 vs 53.6±19.2, p=0.008) and lenght of stay (LOS>7 days, 58.6 vs 37%, p=0.039) were higher in group-AF. Advanced age (OR=1.099, p=0.018) and increased postoperative drainage (OR=1.001, p=0.045) were independent predictors of post-CABG AF.Conclusions: Age and postoperative blood loss are independent predictors of post-CABG AF. β-blocker plus statin therapy seems to be the best medication of choice on reducing the incidence of post-CABG AF. However, new prospective studies about the efficacy of this combination therapy are required.

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