新发心房颤动预示着冠状动脉旁路移植术后的长期死亡率。

New-onset atrial fibrillation predicts long-term mortality after coronary artery bypass graft.

机构信息

Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia 30308, USA.

出版信息

J Am Coll Cardiol. 2010 Mar 30;55(13):1370-6. doi: 10.1016/j.jacc.2009.10.058.

DOI:10.1016/j.jacc.2009.10.058

PMID:20338499

Abstract

OBJECTIVES

We sought to investigate the association between new-onset atrial fibrillation after coronary artery bypass graft (CABG) (post-operative atrial fibrillation [POAF]) and long-term mortality in patients with no history of atrial fibrillation.

BACKGROUND

POAF predicts longer hospital stay and greater post-operative mortality.

METHODS

A total of 16,169 consecutive patients with no history of AF who underwent isolated CABG at our institution between January 1, 1996, and December 31, 2007, were included in the study. All-cause mortality data were obtained from Social Security Administration death records. A multivariable Cox proportional hazards regression model was constructed to determine the independent impact of new-onset POAF on long-term survival after adjusting for several covariates. The covariates included age, sex, race, pre-operative risk factors (ejection fraction, New York Heart Association functional class, history of myocardial infarction, index myocardial infarction, stroke, chronic obstructive pulmonary disease, peripheral arterial disease, smoking, diabetes, renal failure, hypertension, dyslipidemia, creatinine level, dialysis, redo surgery, elective versus emergent CABG, any valvular disorder) and post-operative adverse events (stroke, myocardial infarction, acute respiratory distress syndrome, and renal failure), and discharge cardiac medications known to affect survival in patients with coronary disease.

RESULTS

New-onset AF occurred in 2,985 (18.5%) patients undergoing CABG. POAF independently predicted long-term mortality (hazard ratio: 1.21; 95% confidence interval: 1.12 to 1.32) during a mean follow-up of 6 years (range 0 to 12.5 years). This association remained true after excluding from the analysis those patients who died in-hospital after surgery (hazard ratio: 1.21; 95% confidence interval: 1.11 to 1.32). Patients with POAF discharged on warfarin experienced reduced mortality during follow-up.

CONCLUSIONS

In this large cohort of patients, POAF predicted long-term mortality. Warfarin anticoagulation may improve survival in POAF.

摘要

目的

我们旨在研究冠状动脉旁路移植术（CABG）后新发心房颤动（术后心房颤动[POAF]）与无房颤病史患者的长期死亡率之间的关系。

背景

POAF 可预测住院时间延长和术后死亡率增加。

方法

本研究纳入了 1996 年 1 月 1 日至 2007 年 12 月 31 日期间在我院行单纯 CABG 的 16169 例连续无房颤病史患者。所有原因死亡率数据均来自社会保障管理局的死亡记录。构建了多变量 Cox 比例风险回归模型，以确定在调整了几个协变量后，新发 POAF 对长期生存的独立影响。协变量包括年龄、性别、种族、术前危险因素（射血分数、纽约心脏协会功能分级、心肌梗死史、指数性心肌梗死、中风、慢性阻塞性肺疾病、外周动脉疾病、吸烟、糖尿病、肾衰竭、高血压、血脂异常、肌酐水平、透析、再次手术、择期与紧急 CABG、任何瓣膜疾病）和术后不良事件（中风、心肌梗死、急性呼吸窘迫综合征和肾衰竭），以及已知影响冠心病患者生存的出院心脏药物。

结果

在接受 CABG 的患者中，2985 例（18.5%）发生新发 AF。POAF 独立预测了平均随访 6 年（0 至 12.5 年）期间的长期死亡率（风险比：1.21；95%置信区间：1.12 至 1.32）。在排除手术后住院期间死亡的患者后，这种相关性仍然成立（风险比：1.21；95%置信区间：1.11 至 1.32）。接受华法林治疗的 POAF 患者在随访期间死亡率降低。