Heart and Vascular Center, Case Western Reserve University, MetroHealth Campus, Cleveland, OH 44118, USA.
Circ Arrhythm Electrophysiol. 2011 Oct;4(5):644-52. doi: 10.1161/CIRCEP.111.962670. Epub 2011 Aug 13.
Despite having fewer risk factors for atrial fibrillation (AF), white patients have a greater prevalence of AF in the community than black patients, and a genetic basis has been postulated. However, it is unknown whether occurrence of new-onset AF after cardiac surgery is different in white versus black patients, and secondarily, other non-Caucasian patients.
From 1995 through 2005, 20 282 white, 1323 black, and 1919 other non-Caucasian patients in sinus rhythm underwent coronary artery bypass grafting with or without valve surgery. To adjust for clinical and socioeconomic confounders, we performed propensity-adjusted analyses; 7093 white patients (35%) had postoperative AF, compared with 255 (22%) black patients and 550 (29%) other non-Caucasians (P<0.0001). Whites were older than black patients, had higher socioeconomic position, and greater left atrial size but were less likely to have hypertension or congestive heart failure. In 847 propensity-matched patient pairs, postoperative AF occurred more frequently in white than in black patients (odds ratio, 1.74; 95% confidence interval, 1.7-1.78). Other than higher occurrence of bradycardia requiring pacing and reintubation in white patients, occurrence of other postoperative complications, hospital mortality, and length of postoperative stay were similar. Age and valvular surgery were the strongest predictors of AF irrespective of race.
White patients had a markedly higher risk of postoperative AF than black and other non-Caucasian patients. The cause for racial differences of arrhythmic risk is unknown, but a genetic predisposition is plausible. Our results have implications for risk stratification and mechanistic understanding of postoperative AF.
尽管白人患者发生心房颤动（AF）的风险因素较少，但在社区中，白人患者的 AF 患病率高于黑人患者，这被认为与遗传因素有关。然而，尚不清楚白人患者与黑人患者以及其他非高加索人种患者在心脏手术后新发 AF 的发生率是否存在差异。
1995 年至 2005 年期间，20282 名窦性心律的白人患者、1323 名黑人患者和 1919 名其他非高加索人种患者接受了冠状动脉旁路移植术，伴或不伴瓣膜手术。为了调整临床和社会经济混杂因素，我们进行了倾向评分调整分析；7093 名白人患者（35%）发生术后 AF，相比之下，黑人患者中仅 255 例（22%），其他非高加索人种患者中仅 550 例（29%）（P<0.0001）。白人患者比黑人患者年龄更大，社会经济地位更高，左心房更大，但高血压和充血性心力衰竭的发生率更低。在 847 对倾向评分匹配的患者中，白人患者术后 AF 的发生率高于黑人患者（比值比，1.74；95%置信区间，1.7-1.78）。除了白人患者更常发生需要起搏和重新插管的心动过缓外，其他术后并发症、住院死亡率和术后住院时间的发生率相似。年龄和瓣膜手术是 AF 的最强预测因素，与种族无关。
白人患者术后发生 AF 的风险明显高于黑人患者和其他非高加索人种患者。种族间心律失常风险差异的原因尚不清楚，但遗传易感性是合理的。我们的研究结果对术后 AF 的风险分层和机制理解具有重要意义。
