Department of Cardiothoracic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
Am J Cardiol. 2012 Jan 15;109(2):219-25. doi: 10.1016/j.amjcard.2011.08.033. Epub 2011 Oct 18.
Several studies have shown that postoperative atrial fibrillation (POAF) is associated with poorer short- and long-term outcomes after isolated coronary artery bypass grafting surgery. Nevertheless, there is considerable debate as to whether this reflects an independent association of POAF with poorer outcomes or confounding by other factors. We sought to investigate this issue. Data obtained from June 2001 through December 2009 by the Australasian Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database Program were retrospectively analyzed. Demographic and operative data were compared between patients who developed POAF and those who did not using chi-square and t tests. The independent impact of POAF on 14 short-term complications and long-term mortality was determined using binary logistic and Cox regression, respectively. Excluding patients with preoperative arrhythmia, isolated coronary artery bypass grafting surgery was performed in 19,497 patients. Of these, 5,547 (28.5%) developed POAF. Patients with POAF were generally older (mean age 69 vs 65 years, p <0.001) and presented more often with co-morbidities including congestive heart failure (p <0.001), hypertension (p <0.001), cerebrovascular disease (p <0.001), and renal failure (p = 0.046). Patients with POAF demonstrated a greater 30-day mortality on univariate analysis but not on multivariate analysis (p = 0.376). Patients with POAF were, however, at an independently increased risk of perioperative complications including permanent stroke (p <0.001), new renal failure (p <0.001), infective complications (p <0.001), gastrointestinal complications (p <0.001), and return to the theater (p <0.001). POAF was also independently associated with shorter long-term survival (p = 0.002). In conclusion, POAF is a risk factor for short-term morbidity and decreased long-term survival. Rigorous evaluation of various therapies that prevent or decrease the impact of POAF is imperative. Moreover, patients who develop POAF should undergo strict surveillance and be routinely screened for complications after discharge.
几项研究表明，术后心房颤动（POAF）与孤立冠状动脉旁路移植术后的短期和长期结果较差有关。然而，关于这是否反映了 POAF 与较差结果的独立关联，还是其他因素的混杂因素，仍存在相当大的争议。我们试图调查这个问题。通过澳大利亚心脏和胸外科协会全国心脏手术数据库计划，从 2001 年 6 月至 2009 年 12 月获得的数据进行了回顾性分析。使用卡方检验和 t 检验比较发生 POAF 和未发生 POAF 的患者的人口统计学和手术数据。使用二元逻辑回归和 Cox 回归分别确定 POAF 对 14 种短期并发症和长期死亡率的独立影响。排除术前心律失常患者后，对 19497 例患者进行了孤立冠状动脉旁路移植术。其中，5547 例（28.5%）发生了 POAF。POAF 患者通常年龄较大（平均年龄 69 岁比 65 岁，p<0.001），且更常合并合并症，包括充血性心力衰竭（p<0.001）、高血压（p<0.001）、脑血管病（p<0.001）和肾功能衰竭（p=0.046）。单因素分析显示 POAF 患者 30 天死亡率较高，但多因素分析显示 POAF 患者 30 天死亡率无差异（p=0.376）。然而，POAF 患者发生围手术期并发症的风险增加，包括永久性中风（p<0.001）、新发肾功能衰竭（p<0.001）、感染性并发症（p<0.001）、胃肠道并发症（p<0.001）和重返手术室（p<0.001）。POAF 也与长期生存率较短独立相关（p=0.002）。总之，POAF 是短期发病率和长期生存率降低的危险因素。严格评估预防或降低 POAF 影响的各种治疗方法至关重要。此外，发生 POAF 的患者应接受严格监测，并在出院后常规筛查并发症。
