| Objective Atrial fibrillation(AF) is one of the most common complications after coronary artery bypass grafting(CABG),and also one of the most common postoperative arrhythmia after CABG.Atrial fibrillation, especially rapid atrial fibrillation often cause hemodynamics disorders, increase myocardial oxygen consumption and reduce the myocardial blood.Neutrophil-lymphocyte ratio is the ratio of neutrophil count to lymphocyte count,and is a new systemic inflammation indicator.The latest study shows that the NLR’s predictive of cardiovascular disease was more than total leukocyte count and neutrophil count,and was Helpful for risk stratification of patients with various cardiovascular disease. The purpose is to observe the level of preoperative NLR and the occurence of postoperative AF after off-pump coronary artery bypass grafting(OPCAB). And to explore the association between NLR and AF,and whether the NLR can be used to predict the occurrence of postoperative atrial fibrillation.Methods From January 2009 to September 2014, a total of 502 patients who were undergoing Off-pump coronary artery bypass grafting at Hebei univercity affiliated hospital and Beijing Chaoyang hospital were included for retrospective analysis.we collected the last blood routines before operative and then calculated NLR. Patients were divided into three groups according to NLR. They were the highest(NLR<1.69 n=167)、middle(NLR1.69-2.62n=167)and lowest(NLR>2.62 n=168) group respectively.General clinical data,color doppler echocardiography,operative and postoperative data,electrocardiogram were recorded.Patients were divided into two groups according to atrial fibrillation.Using SPSS10.0 statistical package for each variable comparison among the three groups.The cut-off point was calculated by receiver operating characteristic curve.Binary logistic regression was used to analyze the risk factors of AF.Result A total of 502 patients who undertook OPCAB were included in this study accoding to Inclusion criteria.502 patients with an average age of 62.2 years old(range 37 to 82years).Male, 378 cases(75.3%),female 124 cases(24.7%).Preoperative NLR’s distribution isfrom 0.63 to 20.53,the median is 2.15.The preoperative NLR of female patients was significantly higher than male(2.25, 1.85, P < 0.01).The preoperative NLR of myocardial infarction(ami) patients was significantly higher than no myocardial infarction(ami) patients(2.28, 2.06, P < 0.01).113(22.5%) patients developed AF. Patients who developed AF in the highest,middle and lowest group were 60,29,24 respectively. The incidence rate of AF in the highest group was more than the middle and lowest group(35.7%,17.4%,14.4%,P<0.01).NLR was significantly higher among patients with AF compared to patients without AF(2.71,2.0,P<0.01).On multivariate analysis, age( OR=1.099, 95%CI1.063-1.136,P<0.01),left atrium diameter( OR=2.398,95%CI1.517-3.792,P<0.01),NLR( OR=1.173,95%CI1.067-1.289,P<0.01)were independent risk factors for the presence of AF in patients with OPCAB. The areas under the curve of age,left atrium diameter, NLR and joint of the three factors were 0.696、0.650、0.689、0.753(P<0.01)respectively. Using cut-off points60.5,3.99,2.43 of age,left atrium diameter and NLR respectively,they predicted AF with sensitivity 81.4%,51.3%,67.3% and specificity 48.6%,75.6%,68.1% respectively.Conclusions 1.The preoperative neutrophil–lymphocyte ratio,age and left atrium diameter were risk factors for atrial fibrillation after off-pump coronary artery bypass grafting.2.The preoperative neutrophil–lymphocyte ratio,age and left atrium diameter can predicted atrial fibrillation after OPCAB. |
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