Patients who develop post-operative atrial fibrillation have reduced survival after off-pump coronary artery bypass grafting

Abstract

Objective Post-operative atrial fibrillation (POAF) increases hospital stay, resource utilization, morbidity, and mortality. However, there is paucity of data about its effect in Indian patients undergoing off-pump coronary artery bypass grafting (CABG). Methods Seven hundred forty-eight patients underwent off-pump CABG from January 2015 to December 2016 (24 months). One hundred twenty-seven patients (16.7%) developed POAF. In an effort to mitigate the effects of wider risk factors on perioperative outcomes, a separate sub-analysis of patients based on risks quantified by EuroSCORE II (<> 3) was also performed. Results Age > 60 years and development of sepsis were the independent predictors for the development of POAF. Thirty-day/ mortality rate was higher in the POAF group (7.1% vs. 1.4%; p value < 0.001). POAF was associated with increased ICU and hospital stay and increased incidence of stroke and renal dysfunction. The survival was significantly lower in the POAF group compared with the normal sinus rhythm (NSR) (3-year survival in POAF was 81.3% vs. 94.4% in the NSR group; Hazard ratio (HR) 3.867 (1.989-7.516)). Intra-aortic balloon pump (IABP) usage, age ≥ 60 years and sepsis were independent predictors for the development of POAF in low-risk patients. For the NSR group, 1-year survival was 98% and 3-year survival was 95.7%. For the POAF group, 1-year survival was 94.4% and 3-year survival was 84.0% (HR. 3.794 (1.897-7.591)). Conclusion The incidence of POAF was lower than reported in the wider global literature. Increasing age and development of post-operative sepsis were strong independent predictors of POAF. POAF increases the morbidity; length of hospital stay and these patients show decreased survival after off-pump CABG.

Perioperative risk factors for new-onset postoperative atrial fibrillation after coronary artery bypass grafting: a systematic review

“…The impact of CPB use on the occurrence of POAF after CABG also needs further evaluation. A better understanding of CPB use for CABG would be specifically important as POAF is not only a transient complication of CABG but has long-term effects both in terms of mortality and risk of stroke [8][9][10]. Therefore, further research is essential to enable meta-analysis for variables including intra-and postoperative risk factors for newonset of POAF after CABG.…”

“…Defined as POAF developing within two to four days after CABG, new-onset POAF is identified in 10-40% of patients in the early postoperative period after CABG, with the peak onset at two days postoperatively [4,8]. POAF after CABG increases the length of postoperative hospital stay and is associated with an increased risk of hospital readmission, stroke, and early and late mortality [8][9][10]. Recent research has also indicated that new-onset POAF after CABG has a long-term thromboembolic risk profile similar to that of non-valvular atrial fibrillation (AF) [11,12].…”

Perioperative risk factors for new‐onset postoperative atrial fibrillation among patients after isolated coronary artery bypass grafting: A retrospective study

“…Moreover, several studies have mainly reported the benefits of preoperative or prophylactic IABP (Dieberg et al, 2016;Ghurram et al, 2020;Head et al, 2017). This gap may be related to the indication for IABP usage according to clinical guidelines between countries and patients' health status.…”

“…New‐onset POAF following CABG can lead to prolonged hospitalization, intensive care unit stay and worse long‐term survival as well as increased medical costs (Dobrev et al, 2019; Farouk et al, 2018). Until now, POAF in cardiac care is critical issue, even though the dramatically advances in cardiac surgery and perioperative care (Ghurram et al, 2020; Greenberg et al, 2017). Thus, it is essential to comprehensively identify the potential risk factors for new‐onset POAF after CABG to achieve better patient outcomes after CABG, such as less postoperative complications and long‐term survival rates.…”

Post-operative atrial fibrillation after off-pump coronary artery bypass grafting

“…The prospective study by Ghurram et al [9], later in this issue of the journal, in 748 patients on POAF in Indian patients undergoing off-pump CABG, is a well-conducted study with appropriately designed statistical analysis and the authors are worthy of congratulations for it. In this study, the overall incidence of POAF was 16.7%, which is lower than that of onpump CABG, an observation reported in other studies too.…”