Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Eur J Cardiothorac Surg. 2022 Aug 3;62(3). doi: 10.1093/ejcts/ezac264.
The long-term prognostic role of postoperative atrial fibrillation (POAF) in cardiovascular outcomes in patients undergoing cardiac surgery is uncertain. Our goal was to investigate the impact of new-onset POAF on midterm adverse cardiovascular events after coronary artery bypass graft (CABG) surgery.
We performed a retrospective cohort study of patients who underwent isolated CABG without a preoperative history of atrial fibrillation/flutter. POAF was defined as episodes of AF lasting ≥30 s during the hospitalization period. The effect of POAF on midterm all-cause mortality and cerebrovascular accidents/transient ischaemic attacks (CVA/TIA) was assessed using a Cox proportional hazard regression model in a competing risk setting. Additional analyses were performed on patients surviving an event-free early postoperative period (i.e. within 30 postoperative days after the index operation).
A total of 9,310 patients were followed for a median duration of 48.7 months. New-onset POAF was associated with an increased risk of midterm all-cause mortality (HR = 1.648, 95% confidence interval: 1.402-1.937; P < 0.001) and CVA/TIA (subdistribution-HR = 1.635, 1.233-2.167; P = 0.001). After excluding patients who died during the early postoperative period, POAF remained significantly associated with higher late all-cause mortality (HR = 1.518, 1.273-1.811; P < 0.001). However, the risk of late CVA/TIA in patients who survived the early postoperative period without having a stroke was similar between those with and without POAF (subdistribution-HR = 1.174, 0.797-1.729; P = 0.418).
New-onset POAF after CABG is associated with an increased risk of midterm overall mortality and stroke. However, late stroke risk is likely similar between patients with and without POAF who survive an event-free early postoperative period.
心脏手术后心房颤动（POAF）对心血管结局的长期预后作用尚不确定。我们的目标是研究冠状动脉旁路移植术（CABG）后新发 POAF 对中期不良心血管事件的影响。
我们对无术前心房颤动/扑动病史的接受单纯 CABG 的患者进行了回顾性队列研究。POAF 定义为住院期间持续≥30s 的 AF 发作。使用竞争风险 Cox 比例风险回归模型评估 POAF 对中期全因死亡率和脑血管意外/短暂性脑缺血发作（CVA/TIA）的影响。在无术后早期事件（即指数手术后 30 天内）的患者中进行了额外分析。
共 9310 例患者中位随访时间为 48.7 个月。新发 POAF 与中期全因死亡率（风险比[HR] 1.648，95%置信区间：1.402-1.937；P<0.001）和 CVA/TIA（亚分布 HR 1.635，1.233-2.167；P=0.001）风险增加相关。排除术后早期死亡的患者后，POAF 与晚期全因死亡率（HR 1.518，1.273-1.811；P<0.001）显著相关。然而，在无卒中的早期术后期间无事件存活的患者中，POAF 与晚期 CVA/TIA 的风险相似（亚分布 HR 1.174，0.797-1.729；P=0.418）。
CABG 后新发 POAF 与中期总体死亡率和卒中风险增加相关。然而，在无 POAF 的早期术后期间无事件存活的患者中，晚期卒中风险可能相似。
