Effect of postoperative atrial fibrillation on early and mid-term outcomes of coronary artery bypass graft surgery

Abstract

Objectives The long-term prognostic role of postoperative atrial fibrillation (POAF) on cardiovascular outcomes in patients undergoing cardiac surgery is uncertain. We aimed to investigate the impact of new-onset POAF on mid-term adverse cardiovascular events after coronary artery bypass graft (CABG) surgery. Methods This was 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 seconds during the hospitalization period. The effect of POAF on mid-term 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 surgery). Results 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 mid-term all-cause mortality (HR = 1.648, 95% CI: 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). Conclusions New-onset POAF after CABG is associated with an increased risk of mid-term 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.

Low-normal free triiodothyronine as a predictor of post-operative atrial fibrillation after surgical coronary revascularization

“…POAF is the common complication in patients following CABG. It has been reported that POAF is associated with an increased risk of poor prognosis ( 3 ). It is important to identify risk factors of POAF in order to better prevent POAF.…”

“…New-onset atrial fibrillation (AF) is the most common complications after coronary artery bypass graft (CABG) with a reported incidence of 20–40% ( 1 ). Post-operative AF (POAF) is associated with increased stroke, life-threatening ventricular arrhythmia, mortality and health-care costs ( 2 , 3 ). It is important to identify patients at high risk of developing AF following surgical coronary revascularization.…”

Consequences of a New Onset Postoperative Atrial Fibrillation on Mortality Following Coronary Artery Bypass Grafting

“…However, with an aging population needing heart surgery, there is a greater need for a better knowledge of the impact on patient outcomes, medical facilities, and healthcare costs. Previous research has linked POAF following CABG with both early and late mortality (4). Age is a significant predictor of POAF, which also correlates with early and late mortality following CABG (5).…”

Predicting postoperative atrial fibrillation after off-pump coronary artery bypass surgery—an ongoing story

“…The incidence of POAF in isolated coronary artery bypass grafting (CABG) ranges from 13–33% ( 1 - 5 ). In patients undergoing isolated off-pump coronary artery bypass grafting (OPCABG), the incidence of POAF ranges from 8–20% ( 1 , 2 , 6 - 8 ).…”

“…These include older age, renal failure, impaired left ventricular ejection fraction, diabetes mellitus, chronic obstructive pulmonary disease, use of cardiopulmonary bypass and left atrial size ( 1 , 5 , 6 , 10 , 11 ). Although POAF after cardiac surgery was historically thought to be benign and self-limiting, several studies have now shown that it is associated with a substantial risk for adverse outcomes, including increase in both early and late mortality, morbidities such as postoperative stroke, congestive heart failure, gastrointestinal dysfunction as well as increased length of hospitalization and healthcare costs ( 2 , 12 - 14 ). Considerable efforts have been directed towards the prevention of POAF, mainly focusing on pharmacological agents.…”