Compared with matched controls, patients with postoperative atrial fibrillation (POAF) have increased long-term AF after CABG, and POAF is further associated with increased ischemic stroke, heart failure and mortality even after adjustment for AF

Abstract

Objective To analyze (1) associations between postoperative atrial fibrillation (POAF) after CABG and long-term cardiovascular outcome, (2) whether associations were influenced by AF during follow-up, and (3) if morbidities associated with POAF contribute to mortality. Methods An observational cohort study of 7145 in-hospital survivors after isolated CABG (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012), with preoperative sinus rhythm and without AF history. Incidence of AF was compared with matched controls. Time-updated covariates were used to adjust for POAF-related morbidities during follow-up, including AF. Results Thirty-one percent of patients developed POAF. Median follow-up was 9.8 years. POAF patients had increased AF compared with matched controls (HR 3.03; 95% CI 2.66-3.49), while AF occurrence in non-POAF patients was similar to controls (1.00; 0.89-1.13). The observed AF increase among POAF patients compared with controls persisted over time (> 10 years 2.73; 2.13-3.51). Conversely, the non-POAF cohort showed no AF increase beyond the first postoperative year. Further, POAF was associated with long-term AF (adjusted HR 3.20; 95% CI 2.

Long Term Outcome of Postoperative Atrial Fibrillation After Cardiac Surgery—A Propensity Score-Matched Cohort Analysis

“…Postoperative atrial fibrillation is a secondary AF, but it should be considered as an independent entity. Previous studies have shown that patients with POAF have taken a 3- to 8-time risk of developing future AF and have higher risks of cerebrovascular events and cardiovascular mortality ( 10 , 11 ). However a cohort study demonstrated that AF developing late after operation, rather than POAF, is independently associated with long-term mortality ( 29 ).…”

“…Even though some studies have shown that new-onset POAF following CABG was associated with a significantly higher risk of short and long-term mortality, the long-term stroke risk remained controversial ( 5 , 6 ). Some reported no association ( 7 , 8 ), while some advocated increased risk of stroke after cardiac surgery ( 9 – 11 ).…”

The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation

“…After a median follow-up of more than 6 years, patients with POAF had a higher probability of recurrent AF (25.4% vs 3.6%; adjusted OR, 8.31; 95% CI, 4.20-16.43; P < 0.001), a higher probability of late all-cause mortality (29.7% vs 14.8%; adjusted HR, 1.57; 95% CI, 1.05-2.34; P ¼ 0.027), and a higher probability of death from cerebral ischemia (4.2% vs 0.2%; P < 0.001) compared with patients without POAF. A very recent analysis 807 took this observational comparison further with a larger sample size, prospectively collected data, longer follow-up, and a matched cohort evaluation. This report considered 7145 consecutive Values and preferences.…”

Short-term and Long-term Risk of Stroke in Patients With Perioperative Atrial Fibrillation After Cardiac Surgery: Systematic Review and Meta-analysis

“…While most observational studies have shown an association between POAF and short-term stroke risk, [9][10][11] conflicting results among published studies have raised uncertainty on whether the association persists during long-term follow-up. 3,[12][13][14] Defining the exact magnitude of the excess stroke risk in patients with POAF would be crucial in order to determine whether anticoagulation may have a meaningful effect that outweighs the risks of bleeding. To address these issues, we performed a 5/32 systematic review and meta-analysis evaluating the short-term and long-term relative and absolute risks of stroke in patients with POAF after cardiac surgery.…”