Predictive Roles of Right Coronary Artery Disease Severity and Systemic Immune Inflammation Index in Predicting Atrial Fibrillation After Coronary Bypass Operations in Patients with Right Coronary Artery Disease

Inflammation, Right Coronary Artery and Postoperative Atrial Fibrillation


  • Yusuf Ata, MD University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Cardiovasculer Surgery, Yıldırım/Bursa, Turkey
  • Mustafa Abanoz, MD University of Health Sciences, Mehmet Akif İnan Training and Research Hospital, Department of Cardiovascular Surgery, Karaköprü/Şanlıurfa, Turkey



Postoperative term, Inflammation, Atrial fibrillation, Atherosclerosis, Coronary arteries


Background: Postoperative atrial fibrillation (PoAF) is observed at a rate of 25-40% in the postoperative period after coronary artery bypass graft (CABG) surgery and can increase mortality, morbidity, and treatment costs. Inflammation and coronary artery disease (CAD) severity are important parameters to predict PoAF.

Methods: Patients with right coronary artery (RCA) disease who underwent isolated CABG operation between January 1, 2017 and April 15, 2020, were included in the study retrospectively. Demographic features, preoperative total Gensini score (TGS), right coronary Gensini score (RCGS), systemic immune inflammation index (SII), and postoperative characteristics were recorded.

Results: A total of 283 patients were included in the study. Those who did not develop PoAF were included in Group 1 (N = 211, median age=60 (33-82) years), and those who did were included in Group 2 (N = 72, median age=68 (42-85) years). There were no statistically significant differences between the two groups, in terms of gender, hypercholesterolemia, cerebrovascular event/trans-ischemic attack history, body mass index, diabetes mellitus, smoking, beta blocker/angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use, ejection fraction and left atrium diameters. As a result of multivariate analysis, advanced age (OR: 2.816 CI 95%: 1.687-3.498 P < .001), hypertension (OR:0.896, CI 95%: 0.578-0.965, P = .022), SII (OR: 1.548 CI 95%: 1.265-2.896, P = .003), TGS (OR: 1.235, CI 95%: 1.096-2.424,
P = .012), and RCGS (OR: 2.112, CI 95%: 1.665-4.156,
P < .001) values were determined as independent predictors for predicting postoperative atrial fibrillation.

Conclusion: In this study, we showed that RCGS and SII values were independent predictors of PoAF after CABG operations in patients with right coronary artery disease.


Agus HZ, Kahraman S, Arslan C, Yildirim C, et al. 2020. Systemic immune-inflammation index predicts mortality in infective endocarditis. J Saudi Heart Assoc. 32(1):58-64.

Altinbas O, Tanyeli O, Dereli Y, Ege E. 2019. Predictive value of platelet to lymphocyte ratio and mean platelet volume in atrial fibrillation after isolated coronary artery bypass graft operation. Ann Med Res. 26:1033-8

Çelik E, Çora A, Karadem KB. 2020. Are preoperative neutrophil/lymphocyte, platelet/ lymphocyte, and platelet/neutrophil ratios markers in new-onset atrial fibrillation after coronary artery bypass grafting? Cardiovasc Surg Int. 7(3):113-120.

Dey S, Kashav R, Kohli JK, et al. 2020. Systemic Immune-Inflammation Index Predicts Poor Outcome After Elective Off-Pump CABG: A Retrospective, Single-Center Study. J Cardiothorac Vasc Anesth. S1053-0770(20)31007-7.

Engin M, Ozsin KK, Savran M, et al. 2020. Visceral Adiposity Index and Prognostic Nutritional Index in Predicting Atrial Fibrillation after On-Pump Coronary Artery Bypass Operations: a Prospective Study. Braz J Cardiovasc Surg.

Erdolu B, As AK, Engin M. 2020. The Relationship between the HATCH Score, Neutrophil to Lymphocyte Ratio and Postoperative Atrial Fibrillation After Off-Pump Coronary Artery Bypass Graft Surgery. Heart Surg Forum. 23(1):E088-E092.

Eris C, Engin M, Sunbul SA, et al. 2021. Early Postoperative Results of On-Pump Coronary Endarterectomy: Is Gender a Risk Factor? Heart Surg Forum. 24(4):E662-E669.

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.

Geng Y, Shao Y, Zhu D, et al. 2016. Systemic Immune-Inflammation Index Predicts Prognosis of Patients with Esophageal Squamous Cell Carcinoma: A Propensity Score-matched Analysis. Sci Rep. 21;6:39482.

Hogue CW Jr, Creswell LL, Gutterman DD, Fleisher LA; American College of Chest Physicians. 2005. Epidemiology, mechanisms, and risks: american College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery. Chest. 128(2 Suppl):9S–16S.

Karacaglar E, Akgun A, Ciftci O, Muderrisoglu H. 2019. Gensini score predicts postoperative atrial fibrillation following on-pump coronary artery bypass grafting. Turk J Clin Lab.10(4): 447-451.

Karauzum K, Karauzum I, Celikyurt U, et al.2020. A lower systemic immune-inflammation index level is associated with response to cardiac resynchronization theraphy. Turk J Clin Lab. 11: 186-192.

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

Laffey JG, Boylan JF, Cheng DC. 2002. The systemic inflammatory response to cardiac surgery: Implications for the anesthesiologist. Anesthesiology. 97: 215–252.

Langer HF, Gawaz M. 2008. Platelet-vessel Wall interactions in atheroscleroticdisease. ThrombHaemost. 99(3): 480-486.

Liu Z, Nguyen Khuong J, Borg Caruana C, et al. 2020. The Prognostic Value of Elevated Perioperative Neutrophil-Lymphocyte Ratio in Predicting Postoperative Atrial Fibrillation After Cardiac Surgery: A Systematic Review and Meta-Analysis. Heart Lung Circ. 29(7):1015-1024.

Mariscalco G, Engström KG, Ferrarese S, et al. 2006. Relationship between atrial histopathology and atrial fibrillation after coronary bypass surgery. J Thorac Cardiovasc Surg. 131(6): 1364–72.

Mendes LA, Connelly GP, McKenney PA, et al. 1995. Right coronary artery stenosis: an independent predictor of atrial fibrillation after coronary artery bypass surgery. J Am Coll Cardiol. 25(1):198-202.

Navani RV, Baradi A, Colin Huang KL, et al. 2020. Preoperative Platelet-to-Lymphocyte Ratio Is Not Associated With Postoperative Atrial Fibrillation. Ann Thorac Surg. 110(4):1265-1270.

Neeland IJ, Patel RS, Eshtehardi P, et al. 2012. Coronary angiographic scoring systems: An evaluation of their equivalence and validity. Am Heart J. 164(4):547-52.e1.

Rechavia E, Strasberg B, Mager A. 1992. The incidence of atrial arrhythmias during inferior wall myocardial infarction with and without right ventricular involvement. Am Heart J. 124(2):387-91.

Savran M, Engin M, Guvenc O, et al. 2021. Predictive Value of HATCH Scoring and Waist-to-Height Ratio in Atrial Fibrillation Following Coronary Artery Bypass Operations Performed with Cardiopulmonary Bypass. J Saudi Heart Assoc. 33(2):117-123.

Tang JN, Goyal H, Yu S, Luo H. 2018. Prognostic value of systemic immune-inflammation index (SII) in cancers: a systematic review and meta-analysis. J Lab Precis Med. 3:29

Veltman CE, De Graaf FR, Schuijf JD, et al. 2012. Prognostic value of coronary vessel dominance in relation to significant coronary artery disease determined with non-invasive computed tomography coronary angiography. Eur Heart J. 33(11):1367–1377.

Yamanaka T, Matsumoto S, Teramukai S, et al. 2007. The baseline ratio of neutrophils to lymphocytes is associated with patient prognosis in advanced gastric cancer. Oncology. 73(3-4):215-20.



How to Cite

ATA, Y., & Abanoz, M. (2021). Predictive Roles of Right Coronary Artery Disease Severity and Systemic Immune Inflammation Index in Predicting Atrial Fibrillation After Coronary Bypass Operations in Patients with Right Coronary Artery Disease: Inflammation, Right Coronary Artery and Postoperative Atrial Fibrillation. The Heart Surgery Forum, 24(6), E977-E982.