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Ann Thorac Surg 2009;87:1846-1852. doi:10.1016/j.athoracsur.2009.03.032
© 2009 The Society of Thoracic Surgeons
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Young Joo Park
Kwang Il Kim
Kyung Won Kim
Joong Haeng Choh
Cheong Lim
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Right arrow Electrophysiology - arrhythmias

Original Articles: Adult Cardiac

Subclinical Hypothyroidism Might Increase the Risk of Transient Atrial Fibrillation After Coronary Artery Bypass Grafting

Young Joo Park, MD, PhDa,*, Ji Won Yoon, MDa,*, Kwang Il Kim, MD, PhDa, You Jin Lee, MD, PhDb, Kyung Won Kim, MD, PhDc, Sung Hee Choi, MD, PhDa, Soo Lim, MD, PhDa, Dong Ju Choi, MD, PhDa, Kay-Hyun Park, MD, PhDd, Joong Haeng Choh, MD, PhDd, Hak Chul Jang, MD, PhDa, Seong Yeon Kim, MD, PhDa, Bo Youn Cho, MD, PhDa, Cheong Lim, MD, PhDd,*

a Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Seoul, Korea
d Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Seoul, Korea
b Thyroid Cancer Clinic, National Cancer Center, Gyeonggi-do, Seoul, Korea
c Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea

Accepted for publication March 12, 2009.

* Address correspondence to Dr Cheong Lim, Cardiovascular Center, Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-shi, Gyeonggi-do, 463-707, South Korea (Email: mluemoon{at}snubh.org).

Background: Some studies have proposed that subclinical hypothyroidism (SCH) has adverse effects on the cardiovascular system, but little is known about the effect on patients undergoing cardiovascular operations. We examined the influence of preoperative SCH on postoperative outcome in patients undergoing coronary artery bypass grafting (CABG).

Methods: Among patients who underwent CABG between July 2005 and June 2007 at Seoul National University Bundang Hospital, 224 with normal thyroid function and 36 with SCH were enrolled. Preoperative risks and postoperative outcomes were evaluated prospectively without thyroid hormone replacement.

Results: There were no significant differences in primary outcomes (major adverse cardiovascular events) and secondary outcomes such as wound problems, mediastinitis, leg infection, respiratory complications, delirium, or reoperation during the same hospitalization. However, patients with SCH had a higher incidence of postoperative atrial fibrillation than those with normal thyroid function after adjustment for age, gender, body mass index, and other independent variables such as emergency operation, the use of cardiopulmonary bypass, combined valvular operation, preoperative creatinine levels, left ventricular systolic dysfunction, and nonuse of β-blockers (45.5% vs 29%; odds ratio, 2.552; 95% confidence interval, 1.117 to 5.830; p = 0.026).

Conclusions: SCH appears to influence the postoperative outcome for patients by increasing the development of postoperative atrial fibrillation. However, it is still unproven whether preoperative thyroxine replacement therapy for patients with SCH might prevent postoperative atrial fibrillation after CABG.






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