Hsu Jung-Chi, Huang Chen-Yu, Chuang Shu-Lin, Yu Hsu-Yu, Chen Yih-Sharng, Wang Chih-Hsien, Lin Lian-Yu
Division of Cardiology, Department of Internal Medicine, Camillian Saint Mary's Hospital Luodong, Yilan, Taiwan.
Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Front Cardiovasc Med. 2021 Apr 27;8:650147. doi: 10.3389/fcvm.2021.650147. eCollection 2021.
Postoperative atrial fibrillation (POAF) results in a longer hospital stay and excess mortality. However, whether POAF would increase stroke rate has been debated for years. When and how long should anticoagulation be used to prevent stroke are unknown. In the study, we planned to investigate the clinical demographics and long-term outcomes of POAF after cardiac surgery in a single-center cohort. The cohort study used a database from National Taiwan University Hospital, a single tertiary medical center in Taiwan, between 2007 and 2017, to identify patients with prior normal sinus rhythm developing POAF after cardiac surgery. Patients without POAF after cardiac surgery were used as controls. Propensity score matching with 1:1 ratio and Cox regression models were employed to estimate the risk of transient ischemic accident (TIA) or ischemic stroke. From 2007 to 2017, a total of 8,374 patients received open-heart surgery, in which 1,585 patients with a history of AF were excluded. The overall incidence of TIA/ischemic stroke was 3.9% in a median 9.2-years of follow-up. After propensity matching, 1,965 matched paired subjects were included for analysis. Postoperative atrial fibrillation was associated with an increased risk of future AF [Hazard ratio (HR) 1.40, 95% confidence interval (95%CI) = 1.09-1.79, = 0.008] and heart failure (HF) hospitalization (HR 1.58, 95%CI 1.23-2.04, < 0.001); however, POAF did not significantly correlate with the risk of TIA/ischemic stroke (HR 1.17, 95%CI 0.85-1.60, = 0.043). Kaplan-Meier analysis showed that POAF was a significant predictor for future AF, HF hospitalization, and overall mortality, but not for TIA/ischemic stroke. In the Asian population, POAF after cardiac surgery increased the risk of future AF, HF, and overall mortality, but was not associated with future TIA/ischemic stroke.
术后房颤（POAF）会导致住院时间延长和死亡率增加。然而，POAF是否会增加卒中发生率多年来一直存在争议。何时以及使用抗凝治疗预防卒中多长时间尚不清楚。在本研究中，我们计划在一个单中心队列中调查心脏手术后POAF的临床人口统计学特征和长期预后。该队列研究使用了台湾大学附属医院（台湾一家三级医疗中心）2007年至2017年的数据库，以识别心脏手术后由先前正常窦性心律发展为POAF的患者。将心脏手术后未发生POAF的患者作为对照。采用1:1比例的倾向评分匹配和Cox回归模型来估计短暂性脑缺血发作（TIA）或缺血性卒中的风险。2007年至2017年，共有8374例患者接受了心脏直视手术，其中1585例有房颤病史的患者被排除。在中位9.2年的随访中，TIA/缺血性卒中的总体发生率为3.9%。倾向匹配后，纳入1965对匹配的受试者进行分析。术后房颤与未来发生房颤的风险增加相关[风险比（HR）1.40，95%置信区间（95%CI）=1.09 - 1.79，P = 0.008]以及心力衰竭（HF）住院风险增加相关（HR 1.58，95%CI 1.23 - 2.04，P < 0.001）；然而，POAF与TIA/缺血性卒中的风险无显著相关性（HR 1.17，95%CI 0.85 - 1.60，P = 0.043）。Kaplan - Meier分析表明，POAF是未来房颤、HF住院和总体死亡率的显著预测因素，但不是TIA/缺血性卒中的预测因素。在亚洲人群中，心脏手术后的POAF增加了未来发生房颤、HF和总体死亡率的风险，但与未来的TIA/缺血性卒中无关。
