Caldonazo Tulio, Kirov Hristo, Rahouma Mohamed, Robinson N Bryce, Demetres Michelle, Gaudino Mario, Doenst Torsten
Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, Germany.
Department of Cardiothoracic Surgery at New York Presbyterian, Weill Cornell Medical Center, New York, NY.
J Thorac Cardiovasc Surg. 2023 Jan;165(1):94-103.e24. doi: 10.1016/j.jtcvs.2021.03.077. Epub 2021 Apr 1.
New-onset postoperative atrial fibrillation (POAF) after cardiac surgery is common, with rates up to 60%. POAF has been associated with early and late stroke, but its association with other cardiovascular outcomes is less known. The objective was to perform a meta-analysis of the studies reporting the association of POAF with perioperative and long-term outcomes in patients with cardiac surgery.
We performed a systematic review and a meta-analysis of studies that presented outcomes for cardiac surgery on the basis of the presence or absence of POAF. MEDLINE, EMBASE, and the Cochrane Library were assessed; 57 studies (246,340 patients) were selected. Perioperative mortality was the primary outcome. Inverse variance method and random model were performed. Leave-one-out analysis, subgroup analyses, and metaregression were conducted.
POAF was associated with perioperative mortality (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.58-2.33), perioperative stroke (OR, 2.17; 95% CI, 1.90-2.49), perioperative myocardial infarction (OR, 1.28; 95% CI, 1.06-1.54), perioperative acute renal failure (OR, 2.74; 95% CI, 2.42-3.11), hospital (standardized mean difference, 0.80; 95% CI, 0.53-1.07) and intensive care unit stay (standardized mean difference, 0.55; 95% CI, 0.24-0.86), long-term mortality (incidence rate ratio [IRR], 1.54; 95% CI, 1.40-1.69), long-term stroke (IRR, 1.33; 95% CI, 1.21-1.46), and longstanding persistent atrial fibrillation (IRR, 4.73; 95% CI, 3.36-6.66).
The results suggest that POAF after cardiac surgery is associated with an increased occurrence of most short- and long-term cardiovascular adverse events. However, the causality of this association remains to be established.
心脏手术后新发的术后房颤（POAF）很常见，发生率高达60%。POAF与早期和晚期卒中相关，但其与其他心血管结局的关联尚鲜为人知。目的是对报告POAF与心脏手术患者围手术期及长期结局关联的研究进行荟萃分析。
我们对根据有无POAF呈现心脏手术结局的研究进行了系统评价和荟萃分析。评估了MEDLINE、EMBASE和Cochrane图书馆；选取了57项研究（246,340例患者）。围手术期死亡率是主要结局。采用逆方差法和随机模型。进行了留一法分析、亚组分析和Meta回归分析。
POAF与围手术期死亡率（比值比[OR]，1.92；95%置信区间[CI]，1.58 - 2.33）、围手术期卒中（OR，2.17；95% CI，1.90 - 2.49）、围手术期心肌梗死（OR，1.28；95% CI，1.06 - 1.54）、围手术期急性肾衰竭（OR，2.74；95% CI，2.42 - 3.11）、住院时间（标准化均数差，0.80；95% CI，0.53 - 1.07）和重症监护病房住院时间（标准化均数差，0.55；95% CI，0.24 - 0.86）、长期死亡率（发病率比[IRR]，1.54；95% CI，1.40 - 1.69）、长期卒中（IRR，1.33；95% CI，1.21 - 1.46）以及长期持续性房颤（IRR，4.73；95% CI，3.36 - 6.66）相关。
结果表明，心脏手术后的POAF与大多数短期和长期心血管不良事件的发生率增加相关。然而，这种关联的因果关系仍有待确定。
