Preoperative Platelet Activation Markers as a Risk Predictor of Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting Mahmoud Khairy *1 , Eman NasrEldin 2 and Ali Elsharkawi 3 1 Cardiothoracic Surgery Department, Assiut University, Assiut, Egypt 2 Clinical Pathology Department, Assiut University, Assiut, Egypt 3 Cardiology Department, National Heart Institute, Cairo, Egypt * Corresponding author: Mahmoud Khairy, Cardiothoracic Surgery Department, Assiut University, Assiut, Egypt, Tel: (002)01224579171, E-mail: mahkhairy02@yahoo.com Received Date: December 05, 2018, Accepted Date: December 24, 2018, Published Date: December 27, 2018 Abstract Background: Atrial fibrillation (AF) is the most well-known arrhythmia following coronary artery bypass grafting (CABG) that in turn may lead to a longer hospital stay and a worse postoperative prognoses. AF is known to be a cause of platelet activation; we investigated the relationship between the platelet activation markers and the risk of AF after coronary bypass graft surgery. Methods: Blood was drawn one day before the operation from fifty patients scheduled for isolated on pump CABG. The monocyte–platelet aggregates (MPAs) content were assessed by Flow cytometric quantification analysis. Moreover, soluble CD40 Ligand (sCD40L) level, soluble P-selectin (sP-selectin) and D-dimer levels were quantified by immunological ELISA technique. Post-operative AF (POAF) events were followed up during hospitalization. Results: Post-operative AF (POAF) noticed in 22% of patients, in the first postoperative week. Preoperative levels of both sCD40L, sP-selectin and D-Dimer were significantly higher in those who developed POAF. CD41 expression on monocytes- cellular marker of platelet activation- and the content of MPAs were increased in those patients encountered POAF. Conclusion: Preoperative platelet activation as affirmed by both soluble and cellular markers in addition to the content of MPAs markers seems to be an unprecedented predictor of the postoperative atrial fibrillation. Keywords: Platelet activation markers; Atrial fibrillation; CABG Introduction Post-operative atrial fbrillation (POAF) is prevalent afer coronary artery bypass grafing (CABG). POAF incidences range reported from 25% to 40% [1].Te incidence rang increased in patients who underwent valve procedure with CABG [2,3]. Many proarrhythmic factors are attributed for the occurrence of POAF and the exact mechanism is still unclear, the systemic infammatory response to surgery [4] furthermore, myocardial ischemia accompanied by dysfunctional grafs is of noteworthy signifcant [5]. Valvular or ischemic heart diseases, age-associated degenerative changes in the conductive system or inter atrial impulse conduction disorders could be also implicated [6-8]. Te infammatory processes and AF, in general, could be associated with high level of platelet activation markers. Monocyte–platelet aggregates (MPAs) are precise and sensitive markers to identify platelets activation [9,10]. Te majority of the soluble CD4O Ligand (sCD40L) refects platelet activation and its level is elevated in patients with AF[11]which will increase the risk of thrombosis and stroke during the arrhythmia particularly afer CABG [12,13]. We tested the relation between preoperative platelet activation markers and the risk of POAF in patients in sinus rhythm undergoing on-pump CABG. Methods Study population Te study included 50 patients undergoing isolated on pump CABG in the Cardiothoracic Surgery Department, of Assiut university hospital. Detailed medical history and cardiac investigations data were collected including; Euroscore, lef ventricular function, and lef atrial diameter, history of medication, and any cardiac risk factors before the operation. Selected patients had no history of AF prior to CABG, where patients with history of paroxysmal AF or chronic AF were excluded from the study. Other exclusion criteria included patients on medical treatment (amiodarone or digoxin), patients presenting with an acute coronary syndrome, concomitant valve or vascular surgery, infectious or infammatory disorders, chronic obstructive pulmonary disease (COPD) and thyroid disease. Selected patients were advised to stop antiplatelet medication (aspirin and clopidogrel) one week before surgery. Tose who did not develop postoperative AF during the same period served as the control population (who remained in sinus rhythm until discharge). AF was diagnosed on the basis of abnormalities on 12-lead electrocardiogram (ECG) recording, lasting for at least 30 seconds and was characterized by sustained arrhythmia, irregular RR intervals, absent P waves, and diferent intervals between atrial contractions (cycle<200 ms) According to the guidelines of the European Society of Cardiology, 2010 [8]. Clinical end points Clinical data were collected during the hospital stay, including the length of hospital stay, any major cardiovascular events (like myocardial infarction, unstable angina, need for redo surgery, or death) during postoperative follow-up. Te clinical endpoint of the study was the development of AF of any duration, during hospitalization until discharge. Heart rhythm was monitored continuously for the frst 48 hours postoperatively and at 4- hour intervals thereafer for 2-3 days. Ten by daily ECG until discharge. Khairy et al., Int J Cardiovasc Res 2019, 8:1 DOI: 10.4172/2324-8602.1000401 International Journal of Cardiovascular Research Reearch Article A SCITECHNOL JOURNAL All articles published in International Journal of Cardiovascular Research are the property of SciTechnol and is protected by copyright laws. Copyright © 2019, SciTechnol, All Rights Reserved.