当代心脏手术患者术后房颤的管理及后续结局：来自胸外科医师协会CAPS-Care房颤注册研究的见解
Management of postoperative atrial fibrillation and subsequent outcomes in contemporary patients undergoing cardiac surgery: insights from the Society of Thoracic Surgeons CAPS-Care Atrial Fibrillation Registry.
作者信息
Steinberg Benjamin A, Zhao Yue, He Xia, Hernandez Adrian F, Fullerton David A, Thomas Kevin L, Mills Roger, Klaskala Winslow, Peterson Eric D, Piccini Jonathan P
机构信息
Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
出版信息
Clin Cardiol. 2014 Jan;37(1):7-13. doi: 10.1002/clc.22230. Epub 2013 Dec 18.
BACKGROUND
Postoperative atrial fibrillation (POAF) is a well-recognized complication of cardiac surgery; however, its management remains a challenge, and the implementation and outcomes of various strategies in clinical practice remain unclear.
HYPOTHESIS
We hypothesize that treatment for POAF is variable, and that it is associated with particular morbidity and mortality following cardiac surgery.
METHODS
We compared patient characteristics, operative procedures, postoperative management, and outcomes between patients with and without POAF following coronary artery bypass grafting (CABG) in the Society of Thoracic Surgeons multicenter Contemporary Analysis of Perioperative Cardiovascular Surgical Care (CAPS-Care) registry (2004-2005).
RESULTS
Of 2390 patients who underwent CABG, 676 (28%) had POAF. Compared with patients without POAF, those with POAF were older (median age 74 vs 71 years, P<0.0001) and more likely to have hypertension (86% vs 83%, P=0.04) and impaired renal function (median estimated glomerular filtration rate 56.9 vs 58.6 mL/min/1.73 m2, P=0.0001). A majority of patients with POAF were treated with amiodarone (77%) and β-blockers (68%); few (9.9%) underwent cardioversion. Patients with POAF were more likely to experience complications (57% vs 41%, P<0.0001), including acute limb ischemia (1.0% vs 0.4%, P=0.03), stroke (4.0% vs 1.9%, P=0.002), and reoperation (13% vs 7.9%, P<0.0001). Length of stay (median 8 days vs 6 days, P<0.0001), in-hospital mortality (6.8% vs 3.7%, P=0.001), and 30-day mortality (7.8 vs 3.9, P<0.0001) were all worse for patients with POAF. In adjusted analyses, POAF remained associated with increased length of stay following surgery (adjusted ratio of the mean: 1.27, 95% confidence interval: 1.2-1.34, P<0.0001).
CONCLUSIONS
Postoperative AF is common following CABG, and such patients continue to have higher rates of postoperative complications. Postoperative AF is significantly associated with increased length of stay following surgery.
背景
术后心房颤动（POAF）是心脏手术中一种公认的并发症；然而，其管理仍然是一项挑战，各种策略在临床实践中的实施情况和结果仍不明确。
假设
我们假设POAF的治疗方法存在差异，并且它与心脏手术后特定的发病率和死亡率相关。
方法
我们在胸外科医师协会多中心围手术期心血管外科护理当代分析（CAPS-Care）注册研究（2004 - 2005年）中，比较了冠状动脉旁路移植术（CABG）后发生POAF和未发生POAF的患者的特征、手术操作、术后管理及结果。
结果
在2390例行CABG的患者中，676例（28%）发生了POAF。与未发生POAF的患者相比，发生POAF的患者年龄更大（中位年龄74岁对71岁，P<0.0001），更可能患有高血压（86%对83%，P = 0.04）和肾功能受损（中位估计肾小球滤过率56.9对(58.6) mL/min/1.73 m²，P = 0.0001）。大多数POAF患者接受了胺碘酮（77%）和β受体阻滞剂（68%）治疗；很少（9.9%）进行了心脏复律。POAF患者更可能出现并发症（57%对41%，P<0.0001），包括急性肢体缺血（1.0%对0.4%，P = 0.03）、中风（4.0%对1.9%，P = 0.002）和再次手术（13%对7.9%，P<0.0001）。POAF患者的住院时间（中位8天对6天，P<0.0001）、院内死亡率（6.8%对3.7%，P = 0.001）和30天死亡率（7.8对3.9，P<0.0001）均更差。在调整分析中，POAF仍然与术后住院时间延长相关（调整后的平均比值：1.27，95%置信区间：1.2 - 1.34，P<0.0001）。
结论
CABG术后POAF很常见，此类患者术后并发症发生率仍然较高。术后AF与术后住院时间延长显著相关。
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