Postoperative atrial fibrillation ( POAF ) is a common complication after cardiac surgery and predicts increased morbidity and mortality.
Identification of patients at high risk of postoperative atrial fibrillation with the help of circulating biomarkers may enable early preventive treatment but data are limited, especially in contemporary surgical patients.
Plasma concentrations of N-terminal pro-B-type natriuretic peptide ( NT-proBNP ) and high-sensitivity cardiac troponin T ( hs-cTnT ) were measured at enrollment, on the morning of cardiac surgery, at end surgery, and 2 days postsurgery in 562 patients undergoing cardiac surgery, randomized to perioperative supplementation with oral fish oil or placebo in the OPERA ( Omega-3 Fatty Acids for Prevention of Post-Operative Atrial Fibrillation ) trial.
The primary endpoint was incident postoperative atrial fibrillation lasting greater than or equal to 30 s, centrally adjudicated and confirmed electrocardiographically.
Higher levels of NT-proBNP and hs-cTnT before surgery were associated with older age, renal or cardiac dysfunction and EuroSCORE.
NT-proBNP peaked on postoperative day 2 ( 2172 ng/L, median ), while hs-cTnT peaked at the end of surgery ( 373 ng/L ).
Fish oil supplementation did not alter the time course of the cardiac biomarkers ( P more than 0.05 ).
Concentrations of NT-proBNP or hs-cTnT, on the morning of surgery, or changes in their level between morning of surgery and postsurgery, were not significantly associated with postoperative atrial fibrillation after adjustment for clinical and surgical characteristics.
In conclusion, among patients undergoing cardiac surgery, NT-proBNP and hs-cTnT are related to clinical and surgical characteristics, have different perioperative time courses but are not independently associated with risk of postoperative atrial fibrillation. ( Xagena )
Masson S et al, Eur J Clin Invest 2015;45:170-178