A prospective randomized trial to determine the effects of steroid on the incidence of postoperative atrial fibrillation after coronary artery bypass grafting surgery (CABG)

Background Atrial fibrillation remains one of the most common postoperative complications of coronary artery bypass grafting (CABG). Because of the additional hospital costs associated with this arrhythmia, owing to increased use of antiarrhythmic medications, diagnostic studies, and prolonged hospitalization, this subject continues to draw the interest of cardiac surgeons and cardiologists. Despite many clinical studies, there is still no consensus regarding the best prevention strategy for this arrhythmia. There are several mechanisms that explain why atrial fibrillation occurs after CABG, still the pathophysiological mechanism remains unclear, and therefore mutifactorial causes are likely. One of the mechanisms that we believe is inflammation around the sac of the heart and surgical trauma, including the generalized inflammation response induced by the heart-lung machine. As we know, steroid can decrease the body's response to trauma and inflammation and may reduce the chance of atrial fibrillation occurring. For this reason we design the study to assess the short-term effect of steroid on the incidence of postoperative atrial fibrillation after CABG. Methods This study was done during the time from August 2000 to February 2001 .Eighty-eight consecutive consenting patients were prospectively entered into a randomized, double blind, placebo-controlled trial to determine the efficacy of steroid on the incidence of atrial fibrillation after elective coronary artery bypass grafting. No patient had documented or suspected arrhythmias preoperatively. Two patients were excluded from the study due to Off-PumpCABG, forty-three patients received 1 gm of methyprednisolone before surgery and 4 mg of dexamethasone every 6 hours for one day after surgery, and forty-three patients received only placebo. Results Postoperative atrial fibrillation occurred in 9 of the 43 patients in the steroid group (21 percent) and 22 of the 43 patients in the placebo group (51 percent) (p=0.003). Minor postoperative complications occurred in 15 steroid patients (34 percent) and in 6 patients receiving placebo (14 percent). Major complications occurred in 4 patients who received steroid (9 percent) and in 2 who received placebo (5 percent) (p=0.052) Patients with atrial fibrillation were hospitalized for significantly longer days than were patients with normal sinus rhythm (median 8Vs.6 days, p=0.002); however, the length of hospital stay in Steroid group was 6 days compare with 7 days in Placebo group (p=0.337). Conclusions The use of prophylactic Short-Term Steroid Administration in patients undergoing coronary bypass grafting surgery reduced the incidence of postoperative atrial fibrillation by approximately 50 percent. Patients without postoperative atrial fibrillation had a shorter length of hospital stay. Overall, there was no significant difference between Steroid Group and Placebo Group with regard to the length of hospital stay. In this study, we found that Steroid had higher complications which may contribute to prolonged hospitalization.Surgery, Department ofMedicine, Faculty ofGraduat

PPBP and DEFA1/DEFA3 genes in hyperlipidaemia as feasible synergistic inflammatory biomarkers for coronary heart disease

Abstract Background Coronary heart disease (CHD) is an important complication of atherosclerosis. Biomarkers, which associate with CHD development, are potential to predict CHD risk. To determine whether genes showing altered expression in hyperlipidaemia (H) and coronary heart disease (CHD) patients compared with controls could be CHD risk biomarkers. Methods Control, H, and CHD groups represented atherosclerosis to CHD development. Gene profiling was investigated in peripheral blood mononuclear cells using DNA microarrays. Eight selected genes expressed only in H and CHD groups were validated by real-time quantitative reverse transcription PCR and plasma protein determination. Results α-defensin (DEFA1/DEFA3), pro-platelet basic protein (PPBP), and beta and alpha2 hemoglobin mRNA expression was significantly increased in H and CHD groups compared with controls, but only plasma PPBP and α-defensin proteins were correspondingly increased. Conclusion PPBP and DEFA1/DEFA3 could be potential CHD biomarkers in Thai hyperlipidaemia patients

Interleukin-8 in Hyperlipidemia and Coronary Heart Disease in Thai Patients Taking Statin Cholesterol-Lowering Medication While Undergoing Coronary Artery Bypass Grafting Treatment

The role of interleukin-8 (IL-8), a pivotal chemokine in atherogenesis and coronary heart disease (CHD) development, is diverse and remains unclear. This cross-sectional study investigates the association of the IL-8 expression in hyperlipidemia (H) and CHD patients who have been treated with statin cholesterol-lowering drugs while undergoing coronary artery bypass grafting treatment. Fifty-five Thai volunteers including 13 normal (N), 24 H, and 18 CHD patients were enrolled for the investigation. All the CHD patients had been treated continuously with statin cholesterol-lowering medications since the disease was diagnosed and were undergoing coronary bypass grafting approximately one month later. Therefore, the CHD group was representative of a pathogenesis improvement in CHD. The IL8 mRNA expression was determined by real-time quantitative PCR in the peripheral blood mononuclear cells from heparinized blood. The plasma IL-8 levels were assessed by enzyme-linked immunosorbent assay. The result shows that the IL8 mRNA expression in the H group tended to increase; however, in the CHD group, there was a significant decrease (p=0.0111) compared to the N group. The IL8 mRNA expression and the plasma levels in the CHD group were significantly lower than those in the H group (p<0.05). A significant negative correlation between the IL8 mRNA (r = −0.499) or plasma IL-8 (r = −0.3875) expression and CHD progression was observed (p<0.05). In conclusion, the transcriptomic and the phenotypic IL-8 expression decreased significantly in the Thai CHD patients who had continuously received statin-group medications compared to the H and N group participants. Therefore, IL-8 should serve as a feasible marker and could be used to evaluate the therapeutic effects of statins and illustrate the pathology of CHD treatment