Lilja Mathias, Leaback Richard, Banefelt Jonas, Park Tae Jin, Shah Darshini, Ferguson William G, Friberg Örjan
Quantify Research AB, Stockholm, Sweden.
AbbVie, Marlow, United Kingdom.
JTCVS Open. 2024 Mar 12;19:116-130. doi: 10.1016/j.xjon.2024.03.001. eCollection 2024 Jun.
Postoperative atrial fibrillation (POAF) is the most common perioperative arrhythmia. The association of POAF with negative short-term outcomes after cardiac surgery is well understood; however, the association of POAF with long-term morbidity and mortality is not well described. We compared the risk of long-term clinical outcomes (up to 9 years postdischarge) in patients with and without POAF following open-chest cardiac surgery.
This observational, retrospective cohort study used data from the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) Swedish Cardiac Surgery Registry and National Board of Health and Welfare. Patients aged 55 to 90 years who underwent open-chest coronary artery bypass and/or valvular surgery between 2010 and 2019 were included. Clinical outcomes were adjusted for differences in baseline demographics and clinical history using multivariable Cox regression.
A total of 30,870 patients with a mean age of 69.2 years were included in the study (no POAF, n = 20,734; POAF, n = 10,136). The median follow-up was 4.6 years. After adjustment, POAF was associated with a significantly higher risk of recurrent atrial fibrillation (hazard ratio [HR], 2.30; 95% CI, 2.21-2.41), heart failure (HR, 1.17; 95% CI, 1.10-1.25), chronic kidney disease (HR, 1.15; 95% CI, 1.07-1.24), all-cause mortality (HR, 1.11; 95% CI, 1.04-1.18), and cardiovascular mortality (HR, 1.16; 95% CI, 1.06-1.26). POAF was also associated with a numerically higher risk of ischemic stroke and major bleed, but these findings were not statistically significant after adjustment.
These data provide further insight into the long-term clinical outcomes associated with POAF in patients undergoing cardiac surgery.
术后心房颤动（POAF）是最常见的围手术期心律失常。POAF与心脏手术后短期不良结局之间的关联已为人熟知；然而，POAF与长期发病率和死亡率之间的关联尚无详尽描述。我们比较了开胸心脏手术后发生POAF和未发生POAF的患者的长期临床结局风险（出院后长达9年）。
这项观察性、回顾性队列研究使用了瑞典心脏病循证护理强化与发展网络系统（SWEDEHEART）瑞典心脏手术登记处以及国家卫生与福利委员会的数据。纳入了2010年至2019年间接受开胸冠状动脉搭桥和/或瓣膜手术的55至90岁患者。使用多变量Cox回归对基线人口统计学和临床病史的差异进行临床结局调整。
共有30870例平均年龄为69.2岁的患者纳入研究（未发生POAF，n = 20734；发生POAF，n = 10136）。中位随访时间为4.6年。调整后，POAF与复发性心房颤动风险显著升高相关（风险比[HR]，2.30；95%置信区间[CI]，2.21 - 2.41）、心力衰竭（HR，1.17；95% CI，1.10 - 1.25）、慢性肾脏病（HR，1.15；95% CI，1.07 - 1.24）、全因死亡率（HR，1.11；95% CI，1.04 - 1.18）以及心血管死亡率（HR，1.16；95% CI，1.06 - 1.26）相关。POAF还与缺血性卒中和大出血风险在数值上较高相关，但调整后这些结果无统计学意义。
这些数据为接受心脏手术患者中与POAF相关的长期临床结局提供了进一步的见解。
