Filardo Giovanni, Hamilton Cody, Hebeler Robert F, Hamman Baron, Grayburn Paul
Institute for Health Care Research and Improvement, Baylor Research Institute, Dallas, Tex 76206, USA.
Circ Cardiovasc Qual Outcomes. 2009 May;2(3):164-9. doi: 10.1161/CIRCOUTCOMES.108.816843. Epub 2009 Apr 24.
The advancing age and generally increasing risk profile of patients receiving isolated coronary artery bypass graft (CABG) surgery is expected to raise incidence of new-onset postoperative atrial fibrillation (AFIB) resulting in potentially higher risk of adverse outcomes. In the early postoperative course, new-onset post-CABG AFIB is considered relatively easy to treat and is believed to have little impact on patients' long-term outcome. However, little has been done to determine the effect of new-onset post-CABG AFIB on long-term survival, and this relationship is unclear.
Survival was assessed in a cohort of 6899 consecutive patients without preoperative AFIB who underwent isolated CABG at Baylor University Medical Center, Dallas, Tex, between January 1, 1997 and December 31, 2006; patients who died during CABG were excluded. Ten-year unadjusted survival was 52.3% (48.4%, 56.0%) for patients with new-onset postoperative AFIB and 69.4% (67.3%, 71.4%) for patients without it. A propensity-adjusted model controlling for risk factors identified by the Society of Thoracic Surgeons and other clinical/nonclinical details was used to investigate the association between new-onset AFIB post-CABG and long-term survival. After adjustment, new-onset AFIB post-CABG was significantly associated (hazard ratio, 1.29; 95% CI, 1.16, 1.45) with increased risk of death.
This study provides evidence that new-onset post-CABG AFIB is significantly associated with increased long-term risk of mortality independent of patient preoperative severity. After controlling for a comprehensive array of risk factors associated with post-CABG adverse outcomes, risk of long-term mortality in patients that developed new-onset post-CABG AFIB was 29% higher than in patients without it.
接受单纯冠状动脉旁路移植术（CABG）的患者年龄不断增长，总体风险状况普遍增加，预计术后新发房颤（AFIB）的发生率会上升，从而导致不良后果的潜在风险更高。在术后早期病程中，CABG术后新发房颤被认为相对易于治疗，且据信对患者的长期预后影响较小。然而，关于CABG术后新发房颤对长期生存的影响，目前所做的研究甚少，这种关系尚不清楚。
对1997年1月1日至2006年12月31日期间在德克萨斯州达拉斯市贝勒大学医学中心接受单纯CABG手术、术前无房颤的6899例连续患者的生存情况进行评估；排除在CABG手术期间死亡的患者。术后新发房颤患者的10年未调整生存率为52.3%（48.4%，56.0%），无术后新发房颤患者的10年未调整生存率为69.4%（67.3%，71.4%）。采用倾向调整模型，控制由胸外科医师协会确定的危险因素以及其他临床/非临床细节，以研究CABG术后新发房颤与长期生存之间的关联。调整后，CABG术后新发房颤与死亡风险增加显著相关（风险比，1.29；95%置信区间，1.16，1.45）。
本研究提供的证据表明，CABG术后新发房颤与长期死亡风险增加显著相关，且与患者术前病情严重程度无关。在控制了一系列与CABG术后不良后果相关的危险因素后，发生CABG术后新发房颤患者的长期死亡风险比未发生者高29%。
