冠状动脉搭桥手术后房颤的极晚期效应及其对手术结局的影响

Very late effects of postoperative atrial fibrillation on outcome of coronary artery bypass graft surgery.

作者信息

Haghjoo Majid, Heidarali Mona, Nikfarjam Salman, Peighambari Mohammadmahdi, Alizadeh-Ghavidel Alireza, Hosseini Saeid, Jalali Alireza

机构信息

Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran University of Medical Sciences, Tehran, IR Iran.

Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran University of Medical Sciences, Tehran, IR Iran.

出版信息

Res Cardiovasc Med. 2012 Nov;1(1):23-7. doi: 10.5812/cardiovascmed.4584. Epub 2012 Nov 1.

DOI:10.5812/cardiovascmed.4584

PMID:25478484

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4253888/

Abstract

BACKGROUND

Atrial fibrillation (AF) after coronary artery bypass graft (CABG) is a common complication with potentially higher risk of adverse outcome and prolonged hospital stay.

OBJECTIVE

To determine the impact of postoperative AF (POAF) on long-term outcome in a large cohort of patients who underwent CABG.

PATIENTS AND METHODS

We conducted an observational cohort study of 989 patients who underwent isolated CABG with more than 5-year follow-up. Patient divided in two groups: patients with and without POAF.

RESULTS

In this study, atrial fibrillation developed after CABG in 156 patients (15.8%). Patients with POAF were generally older (P = 0.001) and presented more often with comorbidities including congestive heart failure (P = 0.001), hypertension (P = 0.001), peripheral vascular disease (P = 0.001), hyperlipidemia (P = 0.009), and renal failure (P = 0.001). Five-year mortality was observed in 23 (2.3%) patients. Patients with POAF had higher five-year mortality rate than those without POAF. Multivariate logistic analysis showed that AF after surgery has a strong effect on mortality (HR, 3.3; 95% CI, 0.04-10.8, P = 0.04) and morbidity rates (HR, 4.0; 95% CI, 2.35-6.96, P = 0.001).

CONCLUSIONS

Postoperative atrial fibrillation strongly predicts higher long-term mortality and morbidity following coronary artery bypass graft.

摘要

背景

冠状动脉旁路移植术（CABG）后发生心房颤动（AF）是一种常见并发症，具有不良后果风险更高和住院时间延长的潜在风险。

目的

确定术后房颤（POAF）对接受CABG的大量患者长期预后的影响。

患者与方法

我们对989例接受单纯CABG且随访超过5年的患者进行了一项观察性队列研究。患者分为两组：有POAF和无POAF的患者。

结果

在本研究中，156例患者（15.8%）在CABG后发生心房颤动。有POAF的患者通常年龄较大（P = 0.001），更常出现合并症，包括充血性心力衰竭（P = 0.001）、高血压（P = 0.001）、外周血管疾病（P = 0.001）、高脂血症（P = 0.009）和肾衰竭（P = 0.001）。观察到23例（2.3%）患者5年死亡率。有POAF的患者5年死亡率高于无POAF的患者。多因素逻辑分析显示，术后房颤对死亡率（HR，3.3；95%CI，0.04 - 10.8，P = 0.04）和发病率（HR，4.0；95%CI，2.35 - 6.96，P = 0.001）有强烈影响。