Filardo Giovanni, Pollock Benjamin D, da Graca Briget, Sass Danielle M, Phan Teresa K, Montenegro Debbie E, Ailawadi Gorav, Thourani Vinod H, Damiano Ralph J
Department of Statistical Science, Southern Methodist University, Dallas, Texas.
Department of Epidemiology, Baylor Scott & White Health, Dallas, TX.
Mayo Clin Proc Innov Qual Outcomes. 2020 Dec 10;4(6):630-637. doi: 10.1016/j.mayocpiqo.2020.07.012. eCollection 2020 Dec.
To investigate the impact of limiting the definition of post-coronary artery bypass graft (CABG) atrial fibrillation (AF) to AF/flutter requiring treatment-as in the Society of Thoracic Surgeons' (STS) database- on the association with survival.
We assessed in-hospital incidence of post-CABG AF in 7110 consecutive isolated patients with CABG without preoperative AF at 4 hospitals (January 1, 2004 to December 31, 2010). Patients with ≥1 episode of post-CABG AF detected via continuous in-hospital electrocardiogram (ECG)/telemetry monitoring documented by physicians were assigned to the following: Group 1, identified as having post-CABG AF in STS data and Group 2, not identified as having post-CABG AF in STS data. Patients without documented post-CABG AF constituted Group 3. Survival was compared via a Cox model, adjusted for STS risk of mortality and accounting for site differences.
Over 7 years' follow-up, 16.0% (295 of 1841) of Group 1, 18.7% (79 of 422) of Group 2, and 7.9% (382 of 4847) of Group 3 died. Group 2 had a significantly greater adjusted risk of death than both Group 1 (hazard ratio [HR]: 1.16; 95% confidence interval [CI], 1.02 to 1.33) and Group 3 (HR: 1.94; 95% CI, 1.69 to 2.22).
The statistically significant 16% higher risk of death for patients with AF post-CABG missed vs captured in STS data suggests treatment and postdischarge management should be investigated for differences. The historical misclassification of "missed" patients as experiencing no AF in the STS data weakens the ability to observe differences in risk between patients with and without post-CABG AF. Therefore, STS data should not be used for research examining post-CABG AF.
研究将冠状动脉旁路移植术（CABG）后房颤（AF）的定义限制为需治疗的房颤/心房扑动（正如胸外科医师协会（STS）数据库中那样）对其与生存率之间关联的影响。
我们评估了4家医院（2004年1月1日至2010年12月31日）7110例连续接受单纯CABG且术前无房颤的患者术后房颤的院内发生率。通过医生记录的院内连续心电图（ECG）/遥测监测检测到≥1次CABG后房颤发作的患者被分为以下几组：第1组，在STS数据中被确定为患有CABG后房颤；第2组，在STS数据中未被确定为患有CABG后房颤。未记录有CABG后房颤的患者构成第3组。通过Cox模型比较生存率，并根据STS死亡风险进行调整，同时考虑到不同医院之间的差异。
经过7年的随访，第1组16.0%（1841例中的295例）、第2组18.7%（422例中的79例）和第3组7.9%（4847例中的382例）死亡。第2组的校正死亡风险显著高于第1组（风险比[HR]：1.16；95%置信区间[CI]，1.02至1.33）和第3组（HR：1.94；95%CI，1.69至2.22）。
在STS数据中未被记录而实际患有CABG后房颤的患者死亡风险在统计学上显著高出16%，这表明应研究治疗及出院后管理方面的差异。在STS数据中，“未被记录”的患者被误分类为未发生房颤，这削弱了观察有或无CABG后房颤患者风险差异的能力。因此，STS数据不应被用于研究CABG后房颤。
