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Impact of Multiarterial versus Single Arterial Coronary Bypass Graft Surgery on Postoperative Atrial Fibrillation
Qin Jiang1, Keli Huang1, Shanshan Lin1
1Department of Cardiac Surgery, Sichuan Provincial People's Hospital; Affiliated hospital of University of Electronic Science and Technology, Chengdu, China.
Insights
Multiararterial (MA) coronary bypass graft surgery significantly reduces the incidence and burden of postoperative atrial fibrillation (POAF) compared to single arterial (SA) grafting. This approach also lowers platelet aggregation and inflammation, improving patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Cardiac Electrophysiology
- Pharmacogenomics
Background:
- Postoperative atrial fibrillation (POAF) is a common complication after coronary artery bypass grafting (CABG).
- The comparative effectiveness of multiarterial (MA) versus single arterial (SA) grafting on POAF remains under-investigated.
- Genetic variations, such as CYP2C19*2 or *3 alleles, may influence antiplatelet response and outcomes in patients undergoing CABG.
Purpose of the Study:
- To investigate the effect of MA versus SA coronary bypass graft surgery on the incidence and burden of POAF.
- To compare secondary outcomes including platelet aggregation, systemic immune-inflammation index, and heart rate variability between MA and SA groups.
Main Methods:
- Retrospective review of patients with CYP2C19*2 or *3 alleles undergoing CABG from May 2017 to May 2024, treated with aspirin and clopidogrel.
- Patients were assigned to either the MA group (n=58) or the SA group (n=174).
- Primary endpoint: POAF incidence within the first week. Secondary endpoints: POAF burden, platelet aggregation, inflammation markers, and heart rate variability.
Main Results:
- The incidence of POAF was significantly lower in the MA group (17%) compared to the SA group (42%) (HR 0.353, p=0.0012).
- MA group showed a lower POAF burden (2 hours vs 10 hours, p=0.02), reduced platelet aggregation (p<0.01 for both AA and ADP), and lower inflammation indices (p=0.006 for NLR, p=0.032 for SII).
- Higher heart rate variability (SDNN) and a decreased LF/HF ratio were observed in the MA group, indicating increased parasympathetic tone.
Conclusions:
- Multiararterial coronary bypass grafting is associated with a significantly reduced incidence and burden of postoperative atrial fibrillation compared to single arterial grafting.
- MA grafting demonstrates favorable effects on platelet aggregation, inflammation, and autonomic nervous system balance.
- These findings suggest MA grafting may be a superior strategy for mitigating POAF and improving perioperative outcomes in select patients.
Abstract:
The effect of multiarterial (MA) versus single arterial (SA) coronary bypass graft surgery on postoperative atrial fibrillation (POAF) was not investigated. From May 2017 to May 2024, the patients with CYP2C19*2 or *3 allele receiving coronary artery grafting and postoperational aspirin 100 mg/day and clopidogrel 75 mg/day were retrospectively reviewed and assigned to the MA or SA group. The primary end point was the incidence rate of POAF in the first week. The secondary end points were POAF burden, platelet aggregation, systemic immune-inflammation index, and heart rate variability. The study included 58 cases in the MA group and 174 cases in the SA group. The incidence of POAF was 17% in the MA group, contrasting with 42% in the SA group (hazard ratio 0.353, 95% confidence interval 0.218 to 0.569, p = 0.0012). A lower POAF burden was observed in the MA group than in SA group (2 [1 to 5] vs 10 hours [6 to 20], p = 0.02). Platelet aggregation (arachidonic acid: 46 ± 10% vs 56 ± 8%, p <0.01; adenosine diphosphate: 58 ± 17% vs 75 ± 13%, p <0.01) and inflammation response index (neutrophil to lymphocyte ratio: 26 ± 4 vs 28 ± 5, p = 0.006; systemic immune-inflammation index: 5,019 ± 771 vs 5,382 ± 1,204, p = 0.032) was notably lower in MA group than those in SA group at 1 day after coronary artery bypass grafting. Holter electrocardiogram showed a higher heart rate variability value in the SD of the normal-to-normal RR intervals and decreased low frequency/high frequency ratio in the MA group. In conclusion, MA was associated with a lower incidence rate of POAF and paralleled with a lower atrial fibrillation burden, platelet aggregation, and inflammation reaction and a higher parasympathetic nerve tone than the SA regimen.
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