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Year : 2018  |  Volume : 5  |  Issue : 1  |  Page : 27-34

Plasminogen activator inhibitor-1 as a predictor after cardiopulmonary bypass for postoperative atrial fibrillation

1 Department of Critical Care Medicine, Cairo University, Cairo, Egypt
2 Department of Cardiothoracic Surgery, National Heart Institute, Cairo, Egypt
3 Department of Critical Care Medicine, National Heart Institute, Cairo, Egypt

Correspondence Address:
Suzy Fawzy
PO Box 269, Orman, Giza 12612
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/roaic.roaic_37_17

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Background Following cardiac surgery, atrial fibrillation may be a common event. While postoperative atrial fibrillation (POAF) can be transient, it may lead to serious consequences, such as stroke, hemodynamic instability, and death. Plasminogen activator inhibitor-1 (PAI-1) serves as the primary inhibitor of tissue-type plasminogen activator, but also is mainly an acute-phase reactant. Increased PAI-1 promotes fibrosis and reduces extracellular matrix turnover, which modify the atrial substrate and potentially lead to POAF trigged by cardiac surgery. Aim The aim the study was to assess the efficacy of PAI-1 as a predictor of POAF after cardiopulmonary bypass (CPB). Patients and methods In this study, we enrolled 100 patients undergoing cardiac surgery requiring CPB and were in sinus rhythm at surgery time. Blood samples were obtained for the measurement of PAI-1 in the morning of the operation and immediately after separation from CPB and administration of protamine. Pearson’s χ2-test, Fisher’s exact test, area under the receiver operating characteristic curves, P-value less than 0.05, multivariable binary logistic regression were used. Results This study has shown that the serum level of preoperative PAI-1 more than 15 ng/ml and post-CPB level of PAI-1 more than 23 ng/ml are associated with high incidence of POAF (P<0.01 and 0.01, respectively). Left atrial diameter more than 4 cm (P<0.01), advanced age (>60 years) (P=0.04), hypertension history (P=0.035), number of grafts (P=0.01), Right Coronary Artery (RCA) graft (P<0.01), prolonged time of CPB (P=0.03), postoperative administration of epinephrine and dobutamine (P=0.005), and postoperative reduced ejection fraction less than 35% (P=0.028) are other risk factors for POAF development. Conclusion PAI-1 could be considered as a predictor of POAF whether measured preoperatively or postoperatively immediately after separation from CPB.

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