Abstract P295: Oxidative Stress Biomarkers and Incidence of Post-Operative Atrial Fibrillation in the OPERA Trial
Background: Post-operative atrial fibrillation (PoAF) commonly complicates cardiac surgery. Animal studies point to oxidative stress as a key mechanism triggering PoAF, and yet, the extent to which oxidative stress might relate to PoAF risk in humans remains speculative.
Methods and Results: We assessed the association of validated oxidative stress biomarkers (F2-Isoprostanes, F2-IsoP, Isofurans, IsoF, and F3-Isoprostanes, F3-IsoP) in plasma and urine, with incident PoAF among 551 cardiac surgery patients. Biomarkers were measured using standardized methods at baseline, the end of surgery, and post-op day 2. PoAF lasting ≥ 30seconds was confirmed by rhythm strip or ECG, and centrally adjudicated. Outcomes were assessed until hospital discharge or post-operative day 10, whichever occurred first. Urine level of each oxidative stress biomarkers demonstrated a rise at the end of surgery (2-3 fold over baseline, P<0.001), which subsequently fell and were comparable to baseline by post-op day 2. In contrast, plasma levels remained relatively stable throughout. Urine F2-iso and IsoF at the end of surgery were 20% and 50% higher in subjects who developed PoAF (P≤ 0.009). Baseline biomarker levels did not associate significantly with PoAF, whereas end of surgery and post-op day 2 Isop and IsoF did associate with PoAF. For example, the end of surgery extreme quartile multivariate adjusted odds ratio (95% CI) for urine IsoF and F3-IsoP were 1.95 (1.05-3.62; P for trend = 0.01) and 2.10 (1.04-2.25, P for trend = 0.04), respectively. Analyses using restricted cubic splines suggested continuous (monotonic) associations of biomarkers of oxidative stress at the end of surgery and post-op day 2 with incident PoAF (Figure) There was little evidence that associations of IsoP and IsoF with PoAF varied by demographic, surgery type, and medication use (P≥ 0.29 for each).
Conclusions: Elevated end of surgery and post-op day 2 oxidative stress as assessed by IsoP and IsoF relate independently to higher risk of PoAF.
Author Disclosures: J.H. Wu: None. R. Marchioli: None. R. Latini: None. S. Masson: None. M.G. Silletta: None. F.W. Sellke: None. P. Libby: None. G.L. Milne: None. D. Mozaffarian: B. Research Grant; Significant; GlaxoSmithKline, Sigma Tau, Pronova, the Gates Foundation, the Sackler Institute of Nutrition, and the National Institutes of Health. E. Honoraria; Modest; Ad hoc honoraria for one-time scientific presentations/reviews on diet from Quaker Oats, Pollock Institute, and Bunge. G. Consultant/Advisory Board; Modest; Ad hoc consulting for Foodminds, Nutrition impact, Amerin, Astra Zeneca, Winston and Strawn LLP, and Life Sciences Research Organization, Advisory board: Unilever North America Scientific advisory board. H. Other; Modest; royalties from UpToDate, for an online chapter on fish oil.
- © 2015 by American Heart Association, Inc.