Abstract P103: Higher Preoperative Plasma Aldosterone Concentrations Are Associated With Elevated Risk Of Atrial Fibrillation After Chronic Total Occlusion Percutaneous Coronary Intervention

Abstract

Background: Postoperative atrial fibrillation (POAF) is associated with poor outcomes in patients with coronary chronic total occlusions (CTO). Aldosterone is a steroid hormone that regulates fluid and electrolyte homeostasis and is known to increase the risk of proarrhythmia. This study aimed to explore the additional value of preoperative plasma aldosterone levels for predicting POAF after CTO percutaneous coronary intervention (PCI). Methods: We conducted a prospective cohort study involving consecutive patients with a left ventricular ejection fraction (LVEF) greater than 50% requiring CTO-PCI in the First Affiliated Hospital of Chengdu Medical College. Patients were excluded if they had a history of AF, preoperative endocarditis and/or a ventricular assist device. Plasma aldosterone levels, echocardiography and transforming growth factor beta1 (TGF-β1) examination were assessed before percutaneous recanalization. The primary endpoint was the occurrence of POAF within 30 days after percutaneous recanalization. New-onset POAF after CTO-PCI was defined as any episode detected via continuous in-hospital electrocardiogram/telemetry monitoring and documented by a physician in the chart, regardless of duration or need for treatment. Results: Thirty-eight of 268 (14.2%) patients had POAF. Compared with controls, patients experiencing POAF were significantly older, had a higher body mass index, had diabetes and hypertension, and had higher preoperative plasma aldosterone levels. In logistic regression analysis, higher plasma aldosterone levels exhibited 1.75-fold higher odds (95% confidence interval [CI], 1.15-2.32, P=0.004) for the presence of POAF, which was significant in the adjusted model (odds ratio [OR], 1.82 [95% CI, 1.21-2.45], P=0.007). Reverse transcriptase PCR analysis performed on the left atrial appendage and plasma examination revealed that TGF-β1 was activated in POAF patients. Conclusion: Higher plasma aldosterone levels are associated with increased odds for POAF in patients with CTO-PCI, even in the absence of primary aldosteronism, implying that plasma aldosterone levels might be a target for POAF risk stratification after CTO-PCI.