Comparison of SYNTAX Score I and SYNTAX Score II for Predicting Postoperative Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Graft Surgery
Abstract
Background: Atrial fibrillation is a frequent cause of morbidity following coronary artery bypass grafting (CABG). SYNTAX score II (SSII) is associated with outcomes in patients undergoing coronary revascularization. We investigated the relationship between SSII and postoperative atrial fibrillation (POAF) in patients undergoing CABG.
Methods: Records of 461 consecutive patients who underwent elective isolated CABG were retrospectively reviewed. Characteristics of patients with and without POAF were compared.
Results: POAF developed in 51 (11.1%) patients. Patients with POAF were older (61.8 ± 7.8 versus 58.4±7.7; P = .003). Chronic obstructive pulmonary disease (COPD) and history of coronary artery disease (CAD) were more frequent in patients with POAF whereas the frequency of hypertension (HT), diabetes mellitus (DM), and smoking did not differ. CRP was significantly higher in patients with POAF. Left atrial diameter (LAD), EuroSCORE II, SSI and SSII were greater in patients with POAF (P < .001 for all). Age, history of CAD, LAD, SSI, and SSII were independent predictors of POAF in multivariate regression analysis. In ROC analysis, SSII was more accurate than SSI for predicting POAF, albeit statistically insignificant [difference between AUC: 0.0483, 95% CI (-0.0411) - (0.138); z statistic:1.059, P = .29)]. In-hospital MACE (3.2% versus 9.8%, P = .038) and one-year mortality (4.6% versus 13.5%, P = .008) of patients with POAF were significantly higher.
Conclusion: POAF occurred in more than one-tenth of patients undergoing CABG, and it is associated with in-hospital MACE and one-year mortality. Age, history of CAD, LAD, SSI, and SSII are independent predictors of POAF. SSII seems to be more accurate than SSI for predicting POAF.
References
Abdel-Salam Z, Nammas W. 2017. Incidence and predictors of atrial fibrillation after coronary artery bypass surgery: detection by event loop recorder monitoring from a contemporary multicentre cohort.Acta Cardiol. 72(3):311-317.
Açil T, Cölkesen Y, Türköz R, et al. 2007. Value of preoperative echocardiography in the prediction of postoperative atrial fibrillationfollowing isolated coronary artery bypass grafting. Am J Cardiol. 100(9):1383-6.
Anatoĺevna RO, Veniaminovich FO, Mikhaylovich KS. 2016. Predictors of new-onset atrial fibrillation in elderly patients with coronary artery disease after coronary artery bypass graft. J Geriatr Cardiol. 13(5):444-9.
Bhave P, Passman R. 2012. Age as a Risk factor for Atrial Fibrillation and Flutter after Coronary Artery Bypass Grafting. J Atr Fibrillation. 4(5):482.
Boraita A, Santos-Lozano A, Heras ME, et al. 2018. Incidence of Atrial Fibrillation in Elite Athletes. JAMA Cardiol. 3(12):1200-1205.
Bundhun PK, Bhurtu A, Huang F. 2017. Worse clinical outcomes following percutaneous coronary intervention with a high SYNTAXscore: A systematic review and meta-analysis. Medicine (Baltimore). 96(24):e7140.
Cerit L, Duygu H, Gulsen K, et al. 2016. Is SYNTAX Score Predictive of Atrial Fibrillation after On-Pump Coronary Artery Bypass Graft Surgery? Korean Circ J. 46(6):798-803.
Del Campo A, Roldán J, Verdejo HE, et al. 2017. Increased C-reactive protein plasma levels are not involved in the onset of post-operative atrial fibrillation. J Cardiol. 70(6):578-583.
DiNicolantonio JJ, Beavers CJ, Menezes AR, et al. 2014. Meta-analysis comparing carvedilol versus metoprolol for the prevention of postoperative atrial fibrillation following coronary artery bypass grafting. Am J Cardiol. 113(3):565-9.
Emren V, Aldemir M, Duygu H, et al. 2016. Usefulness of HATCH score as a predictor of atrial fibrillation after coronary artery bypass graft. Kardiol Pol. 74(8):749-753.
Erdem K, Ayhan S, Ozturk S, et al. 2014. Usefulness of the mean platelet volume for predicting new-onset atrial fibrillation after isolated coronary artery bypass grafting. Platelets. 25(1):23-6.
Farouk Musa A, Quan CZ, Xin LZ, et al. 2018. A retrospective study on atrial fibrillation after coronary artery bypass grafting surgery at The National Heart Institute, Kuala Lumpur. F1000Res. 7:164.
Fuller JA, Adams GG, Buxton B. 1989. Atrial fibrillation after coronary artery bypass grafting. Is it a disorder of the elderly? J Thorac Cardiovasc Surg. Jun;97(6):821-5.
Geçmen Ç, Babür Güler G, Erdoğan E, et al. 2016. SYNTAX score predicts postoperative atrial fibrillation in patients undergoing on-pump isolated coronary artery bypass grafting surgery. Anatol J Cardiol. 16(9):655-61.
Hanley JA, McNeil BJ. 1983. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology. 148(3):839-43.
Harada M, Van Wagoner DR, et al. 2015. Role of inflammation in atrial fibrillation pathophysiology and management. Circ J. 79(3):495-502.
Ismail MF, El-Mahrouk AF, Hamouda TH, et al. 2017. Factors influencing postoperative atrial fibrillation in patients undergoing on-pump coronary artery bypass grafting, single center experience. J Cardiothorac Surg. 12(1):40.
Kaw R, Hernandez AV, Masood I, et al. 2011. Short- and long-term mortality associated with new-onset atrial fibrillation after coronary artery bypass grafting: A systematic review and meta-analysis. J Thorac Cardiovasc Surg.141(5):1305-12.
Kılıcgedik A, Naser A, Gurbuz AS, et al. 2018. Red Cell Distribution Width with CHADS2 and CHA2DS2-VASc score is aasociated with Post-operative Atrial Fibrillation after Coronary Artery Bypass Grafting. Heart Surg Forum. 21(3):E170-E174.
Lafarge L, Bourguignon L, Bernard N, et al. 2018. Pharmacokinetic risk factors of beta-blockers overdose in the elderly: Case report and pharmacology approach. Ann Cardiol Angeiol (Paris). 67(2):91-97.
Lieder H, Breithardt G, Heusch G. 2018. Fatal attraction - A brief pathophysiology of the interaction between atrial fibrillation and myocardial ischemia. Int J Cardiol. 254:132-135.
Luo W, Huaibin W, Wenjun Z, et al. 2017. Predictors of Postoperative Atrial Fibrillation after Isolated On-Pump Coronary Artery BypassGrafting in Patients ≥60 Years Old. Heart Surg Forum. 20(1):E038-E042.
Manganas H, Lacasse Y, Bourgeois S, et al. 2007. Postoperative outcome after coronary artery bypass grafting in chronic obstructive pulmonary disease. Can Respir J. 14(1):19-24.
Ozben B, Akaslan D, Sunbul M, et al. 2016. Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting Surgery: A Two-dimensional Speckle Tracking Echocardiography Study. Heart Lung Circ. 25(10):993-9.
Özkan S, Özdemir F, Uğur O, et al. 2017. The effects of the metabolic syndrome on coronary artery bypass grafting surgery. Cardiovasc J Afr. 28(1):48-53.
Romanov A, Pokushalov E, Ponomarev D, et al. 2019. Long-term suppression of atrial fibrillation by botulinum toxin injection into epicardial fat pads in patients undergoing cardiac surgery: Three-year follow-up of a randomized study. Heart Rhythm. 16(2):172-177.
Serruys PW, Kogame N, Katagiri Y, et al. 2019. Clinical outcomes of state-of-the-art percutaneous coronary revascularization in patients with three-vessel disease: 2-year follow-up of the SYNTAX II study. EuroIntervention. Jan 15. [Epub ahead of print].
Verdejo HE, Becerra E, Zalaquet R, et al. 2016. Atrial Function Assessed by Speckle Tracking Echocardiography Is a Good Predictor of Postoperative Atrial Fibrillation in Elderly Patients. Echocardiography. 33(2):242-8.
Vlahou A, Diplaris K, Ampatzidou F, et al. 2016. The Role of Blood Transfusion in the Development of Atrial Fibrillation after Coronary Artery Bypass Grafting. Thorac Cardiovasc Surg. 64(8):688-692.
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).
