Effect of Plasma Level of Vitamin D on Postoperative Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Grafting

Abstract

Objective: Postoperative atrial fibrillation (PoAF) is a common complication after coronary artery bypass grafting (CABG). The aim of the present study was to evaluate the association between development of PoAF and vitamin D levels in patients undergoing isolated CABG.Methods: This prospective randomized clinical trial was conducted on the patients with isolated CABG. The study was terminated when 50 patients in both PoAF(+) group and PoAF(-) group were reached. Development of AF until discharge period was assessed. Vitamin D level was measured immediately after AF; it was measured on the discharge day for the patients without PoAF. Predictive values of the independent variables were measured for the development of PoAF.Results: The groups were separated as PoAF(-) group (66% male, mean age 58.18±10.98 years) and PoAF(+) group (74% male, mean age 61.94±10.88 years). 25(OH) vitamin D level (OR=0.855, 95% CI: 0.780-0.938, P=0.001) and > 65 years (OR=3.525, 95% CI: 1.310-9.483, P=0.013) were identified as an independent predictor of postoperative AF after CABG surgery in multivariate analysis. The cut-off level for 25(OH) vitamin D level in receiver-operating characteristic curve analysis was determined as 7.65 with sensitivity of 60% and specificity of 64% for predicting PoAF (area under the curve: 0.679, P=0.002). Conclusion: Vitamin D level is considered an independent predictor for development of PoAF. Lower vitamin D levels may be one of the reasons for PoAF. Abbreviations, acronyms & symbols 25(OH) vitamin D ACE AF ARB CABG CI COPD CPB ECG ICU OR PoAF RAAS ROC = 25-hydroxy vitamin D = Angiotensin-converting enzyme = Atrial fibrillation = Angiotensin receptor blocker = Coronary artery bypass grafting = Confidence interval = Chronic obstructive pulmonary disease = Cardiopulmonary bypass = Electrocardiography = Intensive care unit = Odds ratio = Postoperative atrial fibrillation = Renin-angiotensin-aldosterone system = Receiver-operating characteristic curve Brazilian Journal of Cardiovascular Surgery Braz J

Atrial fibrillation after cardiac surgery and preoperative vitamin D levels: A systematic review and meta-analysis

“…Among the studies included in this meta-analysis, only Shadvar et al [24] was unable to find a statistically significant difference between the groups. The other studies [21][22][23]25,26] demonstrated that preoperative vitamin D levels were independent predictors of POAF as assessed by univariate regression analysis. Also, Özsin et al, [21] Emren et al, [25] and Gode et al [22] found vitamin D to be an independent predictor according to the multivariate analysis.…”

“…Cerit et al [23] 2017 41 87 + + -Retrospective Non-randomized Gode et al [22] 2016 15 75 + + + Prospective Non-randomized Özsin et al [21] 2018 50 50 + + + Prospective Randomized POAF: Postoperative atrial fibrillation; SR: Sinus rhythm +: Statistically significant; -: Statistically not significant. Only two of studies were randomized (Shadvar et al [24] and Özsin et al [21] ).…”

“…Cerit et al [23] 2017 41 87 + + -Retrospective Non-randomized Gode et al [22] 2016 15 75 + + + Prospective Non-randomized Özsin et al [21] 2018 50 50 + + + Prospective Randomized POAF: Postoperative atrial fibrillation; SR: Sinus rhythm +: Statistically significant; -: Statistically not significant. Only two of studies were randomized (Shadvar et al [24] and Özsin et al [21] ). Vitamin D levels were related with POAF according to univariate logistic regression analysis in all studies except Shadvar et al [24] and Cerit et al [23] and Skuladottir et al [26] could not show any relation according to multivariate regression analysis.…”

“…synthesis and finally, a total of six research studies involving 769 patients were included in the quantitative synthesis. [21][22][23][24][25][26] Demographic data and characteristics of the articles are summarized in Table 1. The overall POAF development rate was 34.98% (269/769).…”

“…Özsin et al [21] -0.736 (-1.141, -0.331) Subgroup randomized (I 2 = 0%, p= 0. we were unable to perform the designs of studies according to time process such as prospective or retrospective, as there was only one retrospective study. [23] The results of the heterogeneity analysis are summarized in Table 2.…”