What is the clinical evidence from this study?

Study design: Cohort. Population: Coronary artery disease requiring CABG (n=34). Intervention: Pre-operative serum sVCAM-1 vs. Lower sVCAM-1 levels. Primary outcome: Prediction of de novo post-operative atrial fibrillation (AUC 0.752, p=0.022).

August 18, 2017Journal of Cardiothoracic Surgery26 citationsOpen Access

Pre-operative serum VCAM-1 as a biomarker of atrial fibrillation after coronary artery bypass grafting

LHLeanne Harling JLJonathan Lambert HAHutan Ashrafian

Key Result

Pre-operative serum sVCAM-1 concentration was significantly elevated in patients who developed post-operative atrial fibrillation, predicting the arrhythmia with an area under the curve of 0.752.

Study Design

Type

Cohort (n=34)

Multicenter

Structured PICO

Does pre-operative serum sVCAM-1 predict the onset of post-operative atrial fibrillation in patients undergoing CABG?

Population

34 patients undergoing non-emergent, on-pump coronary artery bypass grafting, followed for up to 5 days to assess the predictive value of pre-operative sVCAM-1 for post-operative atrial fibrillation.

Exposure

Pre-operative serum soluble vascular endothelial cell adhesion molecule (sVCAM-1) measurement

Outcome

De novo post-operative atrial fibrillation (POAF) defined by continuous Holter recording (at least 30 s) without any pre-operative arrhythmic episodes, monitored until hospital dischargesurrogate

Pre-operative serum sVCAM-1 levels are significantly elevated in patients who develop post-operative atrial fibrillation after CABG, suggesting its potential utility as a predictive biomarker.

Main Result

Effect estimate: AUC 0.752

p-value: p=0.022

Limitations

Small sample size (n=34) increasing the possibility of type II error
Did not determine a causal link between VCAM-1 and the development of POAF
Cannot exclude the possibility that sVCAM-1 is a bystander marker of another sub-clinical attribute such as sub-clinical sepsis
Potential confounding by pre-operative diabetes at the lower biomarker cut-off value

Abstract

OBJECTIVE: Systemic inflammation is a recognised contributory factor in the pathogenesis of de novo post-operative atrial fibrillation after cardiac surgery. This study aims to determine whether serum soluble vascular endothelial cell adhesion molecule (sVCAM-1) may predict the onset of POAF in patients under going coronary artery bypass grafting. METHODS: 34 patients undergoing non-emergent, on-pump CABG were prospectively recruited. Plasma was obtained at 24 h pre-operatively and at 48 and 96 h post-operatively. POAF was defined by continuous Holter recording. Inter-group comparisons were performed using student t-test or ANOVA as appropriate. RESULTS: Thirteen (13/34) patients developed POAF at a mean of 2.5 days post-operatively. Serum sVCAM-1 was significantly increased in the pre-operative serum of POAF when compared to non-POAF patients (p = 0.022). No significant difference was observed between the groups at 48 h (p = 0.073) or 96 h (p = 0.135) post-operatively. sVCAM-1 had a sensitivity of 60.0% and specificity of 77.27%, with an overall diagnostic accuracy of 75.2% in predicting POAF. CONCLUSIONS: sVCAM-1 concentration in the pre-operative serum of patients undergoing CABG may accurately predict the onset of de novo POAF. As such, serum sVCAM-1 may be used as a predictive biomarker for this common arrhythmia. Further work must now perform prospective, targeted validation of these results in a larger patient cohort.

问 AI

Bookmark

View Full Paper