European Heart Journal Advance Access published online on March 27, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp091
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Middle-aged men with increased waist circumference and elevated C-reactive protein level are at higher risk for postoperative atrial fibrillation following coronary artery bypass grafting surgery
1 Department of Surgery, Laval University, 2725 Chemin Ste-Foy, Quebec, Canada G1V-4G5
2 Department of Medicine, Laval University, Québec, Canada
3 Department of Social and Preventive Medicine, Laval University, Québec, Canada
Received 11 September 2008; revised 12 January 2009; accepted 18 February 2009 * Corresponding author. Tel: +1 418 656 4717, Fax: +1 418 656 4707, Email: patrick.mathieu{at}chg.ulaval.ca
Introduction: We recently demonstrated that metabolic syndrome (MetS) is an independent risk factor for postoperative atrial fibrillation (POAF) following coronary artery bypass grafting (CABG). In the present work, we sought to determine which feature of the MetS is associated with POAF.
Methods and results: We retrospectively analysed the association between metabolic features and the incidence of new-onset POAF in a total of 2214 male patients <65 years who underwent first isolated CABG. Anthropometric data including waist circumference (WC) and complete preoperative lipid profile were available. We also conducted a nested case–control substudy including 147 patients who developed POAF, and were matched for age with a control population. In these patients, C-reactive protein, interleukin-6 (IL-6), and thiobarbituric acid-reactive substances (TBARS; evaluating the oxidative stress) blood levels were determined. In the whole cohort, 19.6% of patients developed POAF. On univariate analysis, body mass index (BMI; P = 0.002) and WC (P = 0.001) were the only anthropometric variables significantly associated with increased incidence of POAF. In the multivariable logistic model, the only independent predictors of POAF were a WC > 102 cm [odds ratio (OR) = 1.40, P = 0.04)] and older age (OR = 1.08, P < 0.001). In the nested case–control substudy C-reactive protein, IL-6, and TBARS levels were not significantly different in patients with or without POAF. Of particular significance, patients with elevated WC > 102 cm and C-reactive protein > 1.5 mg/L or IL-6 >2.2 pg/mL were at a high risk of developing POAF (respectively, OR = 2.32, P = 0.02 and OR = 2.27, P = 0.03).
Conclusion: Patients with increased WC combined with elevated C-reactive protein levels are at higher risk for POAF. Thus, interventions targeting inflammation related to visceral obesity might help reducing the incidence of POAF.
Key Words: Postoperative atrial fibrillation • Metabolic syndrome • Coronary artery bypass grafting • Abdominal obesity • Waist circumference • C-reactive protein
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  D. S.H. Bell and J. H. O'Keefe Metabolic syndrome and postoperative atrial fibrillation (POAF) Eur. Heart J., May 2, 2009; 30(10): 1167 - 1168. [Full Text] [PDF]
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