title: Circulating cardiac biomarkers and postoperative atrial fibrillation in the OPERA trial.
abstract: BACKGROUND
  Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery and predicts increased morbidity and mortality. Identification of patients at high risk of POAF with the help of circulating biomarkers may enable early preventive treatment but data are limited, especially in contemporary surgical patients.
  
  
  METHODS
  Plasma concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) were measured at enrollment, on the morning of cardiac surgery, at end surgery, and 2 days postsurgery in 562 patients undergoing cardiac surgery, randomized to perioperative supplementation with oral fish oil or placebo in the Omega-3 Fatty Acids for Prevention of Post-Operative Atrial Fibrillation trial (OPERA). The primary endpoint was incident POAF lasting ≥ 30 s, centrally adjudicated and confirmed electrocardiographically.
  
  
  RESULTS
  Higher levels of NT-proBNP and hs-cTnT before surgery were associated with older age, renal or cardiac dysfunction and EuroSCORE. NT-proBNP peaked on postoperative day 2 (2172 [1238-3758] ng/L, median [Q1-Q3]), while hs-cTnT peaked at the end of surgery (373 [188-660] ng/L). Fish oil supplementation did not alter the time course of the cardiac biomarkers (P > 0.05). Concentrations of NT-proBNP or hs-cTnT, on the morning of surgery, or changes in their level between morning of surgery and postsurgery, were not significantly associated with POAF after adjustment for clinical and surgical characteristics.
  
  
  CONCLUSIONS
  Among patients undergoing cardiac surgery, NT-proBNP and hs-cTnT are related to clinical and surgical characteristics, have different perioperative time courses but are not independently associated with risk of POAF.
authors.affiliation: Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Serge
authors.initials: S
authors.lastname: Masson
authors.forename: Jason H Y
authors.initials: JH
authors.lastname: Wu
authors.forename: Caterina
authors.initials: C
authors.lastname: Simon
authors.forename: Simona
authors.initials: S
authors.lastname: Barlera
authors.forename: Roberto
authors.initials: R
authors.lastname: Marchioli
authors.forename: Javier
authors.initials: J
authors.lastname: Mariani
authors.forename: Alejandro
authors.initials: A
authors.lastname: Macchia
authors.forename: Federico
authors.initials: F
authors.lastname: Lombardi
authors.forename: Tarcisio
authors.initials: T
authors.lastname: Vago
authors.forename: Aneta
authors.initials: A
authors.lastname: Aleksova
authors.forename: Lorella
authors.initials: L
authors.lastname: Dreas
authors.forename: Roberto R
authors.initials: RR
authors.lastname: Favaloro
authors.forename: Alejandro R
authors.initials: AR
authors.lastname: Hershson
authors.forename: John D
authors.initials: JD
authors.lastname: Puskas
authors.forename: Luca
authors.initials: L
authors.lastname: Dozza
authors.forename: Maria G
authors.initials: MG
authors.lastname: Silletta
authors.forename: Gianni
authors.initials: G
authors.lastname: Tognoni
authors.forename: Dariush
authors.initials: D
authors.lastname: Mozaffarian
authors.forename: Roberto
authors.initials: R
authors.lastname: Latini
mesh_terms: D001281:Atrial Fibrillation / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D015415:Biomarkers / Q000378:metabolism; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism*; D010446:Peptide Fragments / Q000378:metabolism*; D011182:Postoperative Care; D011300:Preoperative Care; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D020107:Troponin T / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Cardiac surgery; N-terminal pro-B-type natriuretic peptide; fish oil; high-sensitive cardiac troponin; postoperative atrial fibrillation