Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia.
School of Sciences, RMIT University, Melbourne, Victoria, Australia.
J Am Heart Assoc. 2017 Dec 22;6(12):e007558. doi: 10.1161/JAHA.117.007558.
New-onset atrial fibrillation (NOAF) after coronary artery bypass graft is related to an increased short-term risk of stroke and mortality. We investigated whether the long-term risk of stroke is increased.
We performed a systematic review and meta-analysis of studies that included patients who had coronary artery bypass graft and who afterwards developed NOAF during their index admission; these patients did not have previous atrial fibrillation. The primary outcome was risk of stroke at 6 months or more in patients who developed NOAF compared with those who did not. Odds ratios, relative risk, and hazard ratios were considered equivalent; outcomes were pooled on the log-ratio scale using a random-effects model and reported as exponentiated effect-sizes. We included 16 studies, comprising 108 711 participants with a median follow-up period of 2.05 years. Average participant age was 66.8 years, with studies including an average of 74.8% males. There was an increased long-term risk of stroke in the presence of NOAF (unadjusted studies effect-sizes=1.36, 95% confidence interval, 1.12-1.65, =0.001, adjusted studies effect-sizes=1.25, 95% confidence interval, 1.09-1.42, =0.001). There was evidence of moderate effect variation because of heterogeneity in studies reporting unadjusted (=0.021, I=49.8%) and adjusted data (=0.081, I=49.1%), and publication bias in the latter group (Egger's test, =0.031). Sensitivity analysis on unadjusted data by study quality, design, and surgery did not alter the effect direction.
Presence of NOAF in patients post-coronary artery bypass graft is associated with increased long-term risk of stroke compared with patients without NOAF. Further studies may show whether the increased risk is mediated by atrial fibrillation and whether anticoagulation reduces risk.
冠状动脉旁路移植术后新发心房颤动（NOAF）与短期中风和死亡率增加相关。我们研究了长期中风风险是否增加。
我们对包括冠状动脉旁路移植术后在指数住院期间发生 NOAF 且此前无心房颤动的患者的研究进行了系统评价和荟萃分析。主要结局为与未发生 NOAF 的患者相比，发生 NOAF 的患者在 6 个月或更长时间时的中风风险。比值比、相对风险和风险比被认为是等效的；使用随机效应模型在对数比标度上对结果进行合并，并以指数效应大小报告。我们纳入了 16 项研究，共纳入 108711 名患者，中位随访时间为 2.05 年。参与者平均年龄为 66.8 岁，研究中平均有 74.8%的男性。存在 NOAF 与长期中风风险增加相关（未经调整研究的效应大小=1.36，95%置信区间，1.12-1.65，=0.001，调整研究的效应大小=1.25，95%置信区间，1.09-1.42，=0.001）。由于报告未经调整（=0.021，I=49.8%）和调整数据（=0.081，I=49.1%）的研究存在中度效果变异，以及后者存在发表偏倚（Egger 检验，=0.031），因此存在异质性。按研究质量、设计和手术对未经调整数据进行敏感性分析并未改变效果方向。
与无 NOAF 的患者相比，冠状动脉旁路移植术后患者存在 NOAF 与长期中风风险增加相关。进一步的研究可能会显示增加的风险是否由心房颤动介导，以及抗凝治疗是否降低风险。
