Emir KARAÇAĞLAR, Arzu Neslihan AKGÜN, Orçun ÇİFTÇİ, Haldun MÜDERRİSOĞLU

The Gensini score is a predictor of atrial fibrillation after pump-assisted coronary artery bypass grafting

Aim: Postoperative atrial fibrillation (POAF) is common after coronary artery by-pass grafting surgery (CABG) and associated with adverse events. GENSINI score is a widely-used scoring system that quantifies angiographic atherosclerosis. The value of GENSINI score to predict POAF has not been studied previously. Aim of this study was to evaluate this relationship in our patients undergoing on-pump CABG surgery.Material and Methods: In this retrospective, single-center study, a total of 113 patients without exclusion criteria were included. Demographic and clinical characteristics of patients were recorded and GENSINI scores were calculated. Univariate and multivariate logistic regression analyses were performed to identify the independent predictors of POAF.Results: Postoperative atrial fibrillation developed in 34 (30%) patients. Multivariate logistic regression analyses revealed that C-Reactive Protein [ß=0.037, p=0.011, OR=1.03, 95% CI (1.008-1.065)] and GENSINI score [ß=0.015, p=0.024,OR=1.012, 95% CI (1.002-1.028)] are independent predictors of POAF. The ROC analysis showed an area under the curve of 0.587 (p=0.012). GENSINI score of > 50.75 had 82.4% sensitivity in predicting POAF [p=0.012, 95%CI (0.464-0.711)].Conclusion: Our results showed that GENSINI score is an independent predictor of POAF in patients undergoing on-pump CABG surgery.

Gensini skoru pompa destekli koroner arter baypas greftleme sonrası gelişen atriyal fibrilasyonun öngördürücüsüdür

Amaç: Postoperatif atriyal fibrilasyon (POAF), koroner arter baypas cerrahisi (CABG) sonrası sıktır ve istenmeyen olaylarla ilişkilidir. GENSINI skoru anjiyografik aterosklerozu derecelendirmek için yaygın olarak kullanılan bir skorlama sistemidir. POAF gelişiminin öngörülmesinde GENSINI skorunun rolü daha önce araştırılmamıştır. Bu çalışmada pompa destekli CABG yapılan hastalarda POAF gelişiminin öngörülmesinde GENSINI skorunun rolünün değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Tek merkezde gerçekleştirilen bu retrospektif çalışmaya dışlama kriterleri olmayan 113 hasta dahil edildi. Demografik ve klinik özellikleri kaydedildi. GENSINI skorları hesaplandı. Postoperatif atriyal fibrilasyon gelişimi öngördürücülerini belirlemek amacıyla tek değişkenli ve çok değişkenli lojistik regresyon analizi yapıldı. Bulgular: Hastaların %30’unda POAF gelişti. Çok değişkenli lojistik regresyon analizinde C-Reaktif Protein [ß=0.037, p=0.011, OR=1.03, 95% CI (1.008-1.065)] ve GENSINI skorunun [ß=0.015, p=0.024,OR=1.012, 95% CI (1.002-1.028)] postoperatif atriyal fibrilasyon gelişiminin bağımsız öngördürücüleri olduğu bulundu. Alıcı işletim karakteristiği (ROC) analizinde eğri altında kalan alan GENSINI skoru için 0.587 olarak hesaplandı. GENSINI skorunun 50.75’ in üzerinde olmasının POAF gelişiminin öngörülmesinde % 82.4 duyarlılığa sahip olduğu saptandı [p=0.012, 95%CI (0.464-0.711) ]. Sonuç: Çalışmamızda GENSINI skorunun pompa destekli bypass cerrahisi uygulanan hastalarda POAF gelişiminin bağımsız bir öngördürücüsü olduğu bulunmuştur.

PDF

___

Kirchhof P, Benussi S, Kotecha D et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur J Cardiothorac Surg 2016; 50: 1-81

Oktay V, Cirali IC, Sinan UY et al. Validation of SYNTAX and clinical SYNTAX scores in predicting atrial fibrillation following on-pump coronary artery bypass grafting Turk Gogus Kalp Dama 2017; 25: 333-39.

Ahlsson A, Fengsrud E, Bodin L, Englund A. Postoperative atrial fibrillation in patients undergoing aortocoronary bypass surgery carries an eightfold risk of future atrial fibrillation and a doubled cardiovascular mortality. Eur J Cardiothorac Surg 2010; 37: 1353-59.

Rogers CA, Angelini GD, Culliford LA, Capoun R, Ascione R. Coronary surgery in patients with preexisting chronic atrial fibrillation: early and midterm clinical outcome. Ann Thorac Surg 2006; 81: 1676-82.

Gensini GG A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol 1983; 51: 606.

Chiha J, Mitchell P, Gopinath B et al. Prediction of coronary artery disease extent and severity using pulse wave velocity. PLoS One 2016; 22; 11: 0168598.

Avci A, Fidan S, Tabakci MM et al. Association between the Gensini Score and Carotid Artery Stenosis. Korean Circ J 2016; 46: 639-45.

Mariscalco G, Engström KG. Postoperative atrial fibrillation is associated with late mortality after coronary surgery, but not after valvular surgery. Ann Thorac Surg 2009; 88: 1871-76.

Altındeger N, Dogan A, Bolukcu A et al. Usefulness of troponin I for prediction of atrial fibrillation after coronary artery bypass grafting. Turk Gogus Kalp Dama 2016; 24: 439-45.

10. Yildirim E, Iyisoy A, Celik M et al. The Relationship Between Gensini Score and In-Hospital Mortality in Patients with ST Segment Elevation Myocardial Infarction. International Journal of Cardiovascular Sciences 2017; 30: 32-41.

11. Banach M, Rysz J, Drozdz JA et al. Risk factors of atrial fibrillation following coronary artery bypass grafting: a preliminary report. Circ J 2006; 70: 438-41.

12. Mariscalco G, Engström KG, Ferrarese S, et al. Relationship between atrial histopathology and atrial fibrillation after coronary bypass surgery. J Thorac Cardiovasc Surg 2006; 131: 1364-72.

13. Al-Shanafey S, Dodds L, Langille D, Ali I, Henteleff H, Dobson R. Nodal vessels disease as a risk factor for atrial fibrillation after coronary artery bypass graft surgery. Eur J Cardiothorac Surg 2001; 19: 821-26.

14. Gecmen C, Babur Guler G, Erdogan E et al. SYNTAX score predicts postoperative atrial fibrillation in patients undergoing on-pump isolated coronary artery bypass grafting surgery. Anatol J Cardiol. 2016; 16: 655-61.

15. Fukui T, Uchimuro T, Takanashi S. EuroSCORE II with SYNTAX score to assess risks of coronary artery bypass grafting outcomes. Eur J Cardiothorac Surg 2015; 47: 66-71.