Plasminogen activator inhibitor-1 as a predictor of postoperative atrial fibrillation after cardiopulmonary bypass
Plasminogen activator inhibitor-1 as a predictor of postoperative atrial fibrillation after cardiopulmonary bypass
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DOI：
10.1161/circulationaha.106.677906
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发表时间：
2007-09-11
期刊：
影响因子：
37.8
通讯作者：
Brown, Nancy J.
中科院分区：
文献类型：
--
作者：
Pretorius, Mias;Donahue, Brian S.;Brown, Nancy J.
背景 - 术后心房颤动 (AF) 会导致显着的发病率和住院时间延长，使 20% 至 40% 需要体外循环 (CPB) 的外科手术变得复杂。这项研究检验了生物标志物预测术后 AF 发展的假设。方法和结果 - 我们招募了 253 名接受体外循环（CPB）的择期心脏手术且手术时处于窦性心律的成年患者。从 CPB 分离并施用鱼精蛋白后立即获取血样用于测量 21 种生物标志物。术后发生房颤的患者（67 名受试者，26.5%）年龄明显较大（P < 0.001），更有可能有远期房颤病史（P < 0.001），并且更有可能接受过瓣膜手术（P = 0.082）。术后发生 AF 的患者血液中纤溶酶原激活剂抑制剂-1 (P = 0.014)、白细胞介素 (IL)-6 (P = 0.019) 和 N 末端激素原脑钠肽 (P = 0.028) 浓度显着升高。 Logistic 回归将年龄 (P < 0.001)、远期 AF 病史 (P = 0.001) 和术后 PAI-1 (P = 0.036) 确定为术后 AF 的独立预测因子。当术前 PAI-1 抗原浓度包含在模型年龄中时 (P < 0.001)，远期 AF 病史 (P < 0.001) 和术前 PAI-1 (P = 0.015) 被确定为术后 AF 的独立预测因子。卡方自动交互检测 (CHAID) 模型表明，年龄是术后发生 AF 的主要决定因素（17% 年龄为 67.3 岁）。在较年轻的患者中（年龄
Background - Postoperative atrial fibrillation (AF), leading to significant morbidity and prolongation of hospital stay, complicates 20% to 40% of surgical procedures requiring cardiopulmonary bypass (CPB). This study tests the hypothesis that biomarkers predict the development of postoperative AF.Methods and Results - We enrolled 253 adult patients undergoing elective cardiac surgery requiring CPB and who were in sinus rhythm at the time of surgery. Blood samples were obtained for measurement of 21 biomarkers immediately after separation from CPB and administration of protamine. Patients who developed postoperative AF (67 subjects, 26.5%) were significantly older (P < 0.001), more likely to have a remote history of AF (P < 0.001), and tended to be more likely to have had valve surgery (P = 0.082). Plasminogen activator inhibitor-1 (P = 0.014), interleukin (IL)-6 (P = 0.019), and N-terminal prohormone brain natriuretic peptide (P = 0.028) concentrations were significantly higher in the blood of patients who developed postoperative AF. Logistic regression identified age (P < 0.001), remote history of AF (P = 0.001), and postoperative PAI-1 (P = 0.036) as independent predictors of postoperative AF. When preoperative PAI-1 antigen concentrations were included in the model age (P < 0.001), remote history of AF (P < 0.001) and preoperative PAI-1 (P = 0.015) were identified as independent predictors of postoperative AF. The Chi-squared Automatic Interaction Detection (CHAID) model indicated that age was the primary determinant for the development of postoperative AF (17% in age 67.3 years). Within younger patients (age