Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark.
JAMA Cardiol. 2019 Nov 1;4(11):1139-1147. doi: 10.1001/jamacardio.2019.3649.
New-onset postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery. However, data on the long-term risk of thromboembolism in patients who develop POAF after heart valve surgery are conflicting. In addition, data on stroke prophylaxis in this setting are lacking.
To assess the long-term risk of thromboembolism in patients developing new-onset POAF after isolated left-sided heart valve surgery relative to patients with nonsurgical, nonvalvular atrial fibrillation (NVAF).
DESIGN, SETTING, AND PARTICIPANTS: This observational cohort study was conducted from January 1, 2000, through December 31, 2015, using Danish nationwide registries and the Eastern Danish Heart Surgery Database. Patients who developed POAF after isolated left-sided heart valve surgery (bioprosthetic aortic or mitral valve replacement and/or aortic or mitral valve repair) from 2000 through 2015 were included. These patients were matched with patients with nonsurgical NVAF in a 1:3 ratio by age, sex, heart failure, hypertension, diabetes, a history of thromboembolism, ischemic heart disease, and year of diagnosis. Data analyses took place from January to March 2019.
Rates of thromboembolism.
Of the 1587 patients who underwent isolated left-sided heart valve surgery, 741 patients (46.7%) developed POAF during admission. Of the 712 patients with POAF who were eligible for matching, 675 patients were matched with 2025 patients with NVAF and made up the study population. In the matched study population, the median age was 71 (interquartile range, 65-77) years, and 1600 (59.3%) were men. Oral anticoagulation therapy was initiated within 30 days postdischarge in 420 patients with POAF (62.9%) and in 1030 patients with NVAF (51.4%). The crude incidence rates of thromboembolism were 21.9 (95% CI, 17.4-27.6) and 17.7 (95% CI, 15.2-20.6) events per 1000 person-years for patients with POAF and patients with NVAF, respectively. In the adjusted analysis, the long-term risk of thromboembolism was similar in patients with POAF and NVAF (hazard ratio, 1.22 [95% CI, 0.88-1.68]). Oral anticoagulation therapy during follow-up was associated with a lower risk of thromboembolic events in patients with POAF (hazard ratio, 0.45 [95% CI, 0.22-0.90]) as well as patients with NVAF (hazard ratio, 0.63 [95% CI, 0.45-0.87]) compared with no anticoagulation therapy.
New-onset POAF after isolated left-sided heart valve surgery was associated with a similar long-term risk of thromboembolism as NVAF. These data warrant studies addressing the role of anticoagulation therapy in POAF after left-sided heart valve surgery.
心脏手术后新发术后心房颤动（POAF）是心脏手术的常见并发症。然而，关于发生瓣膜手术后 POAF 的患者长期血栓栓塞风险的数据存在争议。此外，在这种情况下缺乏关于卒中预防的数据。
评估与非手术、非瓣膜性心房颤动（NVAF）患者相比，行左侧心脏瓣膜手术后新发 POAF 的患者的长期血栓栓塞风险。
设计、设置和参与者：这是一项从 2000 年 1 月 1 日至 2015 年 12 月 31 日进行的观察性队列研究，使用丹麦全国登记处和丹麦东部心脏手术数据库。2000 年至 2015 年间接受过左侧心脏瓣膜手术（生物瓣主动脉瓣或二尖瓣置换和/或主动脉瓣或二尖瓣修复）后发生 POAF 的患者被纳入研究。通过年龄、性别、心力衰竭、高血压、糖尿病、血栓栓塞史、缺血性心脏病和诊断年份，将这些患者与 3:1 比例的 NVAF 患者进行匹配。数据分析于 2019 年 1 月至 3 月进行。
血栓栓塞事件的发生率。
在 1587 例行左侧心脏瓣膜手术的患者中，741 例（46.7%）在住院期间发生 POAF。在符合匹配条件的 712 例 POAF 患者中，有 675 例与 2025 例 NVAF 患者进行了匹配，并构成了研究人群。在匹配的研究人群中，中位年龄为 71（四分位距，65-77）岁，1600 例（59.3%）为男性。在 420 例 POAF 患者（62.9%）和 1030 例 NVAF 患者（51.4%）中，在出院后 30 天内开始口服抗凝治疗。POAF 患者和 NVAF 患者的血栓栓塞事件发生率分别为每 1000 人年 21.9（95%CI，17.4-27.6）和 17.7（95%CI，15.2-20.6）。在调整分析中，POAF 患者和 NVAF 患者的长期血栓栓塞风险相似（风险比，1.22[95%CI，0.88-1.68]）。在 POAF 患者（风险比，0.45[95%CI，0.22-0.90]）和 NVAF 患者（风险比，0.63[95%CI，0.45-0.87]）中，与未抗凝治疗相比，随访期间进行口服抗凝治疗与血栓栓塞事件风险降低相关。
左侧心脏瓣膜手术后新发 POAF 与 NVAF 一样，长期血栓栓塞风险相似。这些数据需要进一步研究口服抗凝治疗在左侧心脏瓣膜手术后 POAF 中的作用。
