title: Impact of coronary collateral circulation and severity of coronary artery disease in the development of postoperative atrial fibrillation.
abstract: OBJECTIVE
  Atrial fibrillation (AF) after cardiac surgery has been reported to be approximately 30%, making it one of the most important causes of morbidity and mortality post surgery. Although various clinical and laboratory predictors and underlying mechanisms progressing to postoperative AF have been proposed, the role of ischaemia in pathogenesis is doubtful. In this study, the association of coronary collateral circulation (CCC) and severity of coronary artery disease (CAD) with the development of postoperative AF was investigated.
  
  
  METHODS
  A total of 597 patients who underwent on-pump coronary artery bypass surgery were included in the study. Pre-, peri- and postoperative variables were recorded in a computerized database. CCC and severity of CAD were documented for each patient according to Rentrop classification and Gensini score.
  
  
  RESULTS
  Postoperative AF was observed in 96 patients (16.1%). Advanced age, female gender, presence of hypertension and low haematocrit level were significantly associated with postoperative AF. By contrast, CCC and severity of CAD were not associated with postoperative AF (P = 0.22 and 0.5, respectively). Older age and lower preoperative haematocrit levels were the major predictors of postoperative AF development in the multivariate regression analysis.
  
  
  CONCLUSIONS
  CCC and severity of CAD did not have a significant effect on the occurrence of postoperative AF, suggesting an ineffective role of myocardial ischaemia in the development of this condition.
authors.affiliation: Department of Cardiology, Bağcılar Training and Research Hospital, İstanbul, Turkey medirfansahin@gmail.com.
authors.forename: İrfan
authors.initials: İ
authors.lastname: Sahin
authors.affiliation: Department of Cardiovascular Surgery, Bağcılar Training and Research Hospital, İstanbul, Turkey.
authors.forename: Berk
authors.initials: B
authors.lastname: Özkaynak
authors.affiliation: Department of Cardiology, Acıbadem University, Acıbadem Atakent Hospital, İstanbul, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Karabulut
authors.affiliation: Department of Cardiology, Bağcılar Training and Research Hospital, İstanbul, Turkey.
authors.forename: Ilhan İlker
authors.initials: Iİ
authors.lastname: Avcı
authors.affiliation: Department of Cardiology, Bağcılar Training and Research Hospital, İstanbul, Turkey.
authors.forename: Ertuğrul
authors.initials: E
authors.lastname: Okuyan
authors.affiliation: Department of Cardiovascular Surgery, Bağcılar Training and Research Hospital, İstanbul, Turkey.
authors.forename: Bülent
authors.initials: B
authors.lastname: Mert
authors.affiliation: Department of Cardiology, Bağcılar Training and Research Hospital, İstanbul, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Avşar
authors.affiliation: Department of Cardiology, Bağcılar Training and Research Hospital, İstanbul, Turkey.
authors.forename: Fahrettin
authors.initials: F
authors.lastname: Turna
authors.affiliation: Department of Cardiovascular Surgery, Bağcılar Training and Research Hospital, İstanbul, Turkey.
authors.forename: Nihan
authors.initials: N
authors.lastname: Kayalar
authors.affiliation: Department of Cardiovascular Surgery, Bağcılar Training and Research Hospital, İstanbul, Turkey.
authors.forename: Vedat
authors.initials: V
authors.lastname: Erentuğ
authors.affiliation: Department of Cardiology, Bağcılar Training and Research Hospital, İstanbul, Turkey.
authors.forename: Mustafa Hakan
authors.initials: MH
authors.lastname: Dinçkal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D016009:Chi-Square Distribution; D003097:Collateral Circulation; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D003326:Coronary Circulation; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Atrial fibrillation; Cardiac surgery; Gensini score; Ischaemia; Rentrop grade