Postoperative atrial fibrillation is a major cause of stroke after on-pump coronary artery bypass surgery

Lahtinen, Jarmo; Biancari, Fausto; Salmela, Esa; Mosorin, Martti; Satta, Jari; Rainio, Pekka; Rimpiläinen, Jussi; Lepojärvi, Martti; Juvonen, Tatu

doi:10.1016/j.athoracsur.2003.09.077

Cited by 186 publications

(84 citation statements)

References 11 publications

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“…Postoperative stroke has been associated with the extent of cerebral artery atherosclerosis, 22 extent of atherosclerotic ascending aortic disease, 23 older age, on-pump CABG surgery with hypothermia circulatory arrest, 24 increased cardiopulmonary bypass duration, 25 and POAF. 25,20 However, the historical association between POAF and stroke has been inconsistent. 26 The lack of association between POAF and stroke was recently supported in another large, 45 000-patient post-CABG study.…”

Section: Resultsmentioning

confidence: 99%

Postoperative Atrial Fibrillation Is Not Associated With an Increase Risk of Stroke or the Type and Number of Grafts: A Single‐Center Retrospective Analysis

Lotfi

Wartak

Sethi

et al. 2011

Clinical Cardiology

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Background:Atrial fibrillation (AF) and atrial flutter are the 2 most common types of dysrhythmia in patients undergoing coronary artery bypass graft (CABG) surgery and are associated with increased morbidity and mortality. We sought to explore the association between the type and quantity of bypass grafts and cardiovascular outcomes in patients with postoperative AF (POAF).Hypothesis:The type and quantity of bypass grafts is associated with POAF.Methods:We queried the Society of Thoracic Surgery National Database for CABG operations, both with and without valve procedures, performed at Baystate Medical Center between January 2002 and July 2007. We used multivariable logistic regression modeling to identify predictors of POAF and to explore the impact of AF on major adverse cardiac outcomes in this post‐CABG population.Results:A total of 3068 patients received CABG surgery, 187 (6.1%) of whom received concurrent valve replacement or repair. The incidence of POAF was 38.3%. POAF was significantly associated with readmission within 30 days (P < 0.009), increased length of stay (P << 0.0001), and a strong trend toward increased 30 day mortality (P = 0.058). There was no association between POAF and postoperative stroke (P = 0.92), graft type (P = nonsignificant) or number of grafts (P = nonsignificant).Conclusions:Patients with POAF experienced increased morbidity and mortality as demonstrated by previous studies. Neither the number of grafts nor type of grafts was associated with POAF. Furthermore, the rate of stroke was not associated with POAF. © 2011 Wiley Periodicals, Inc.The authors have no funding, financial relationships, or conflicts of interest to disclose.

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Section: Resultsmentioning

confidence: 99%

Postoperative Atrial Fibrillation Is Not Associated With an Increase Risk of Stroke or the Type and Number of Grafts: A Single‐Center Retrospective Analysis

Lotfi

Wartak

Sethi

et al. 2011

Clinical Cardiology

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“…Although the causes for postoperative AF after esophagectomy have not been completely disclosed, we speculate that AF after esophagectomy is precipitated by the resolution of inflammatory response following blunt or sharp surgical trauma to sympathovagal nerve fibers supplying the heart, which alters the autonomic modulation of atrial myocardial cells to endogenous catecholamines. Although postoperative AF is self-limited in most cases, it can increase the risk of postoperative stroke [28] . The treatment of postoperative AF requires a prolonged hospital stay and additional costs.…”

Section: Discussionmentioning

confidence: 99%

Transrectal EUS-guided FNA biopsy of a presacral chordoma-report of a case and review of the literature

Hou

Gao²,

Li³

et al. 2008

WJG

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AIM:To evaluate the value of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) level for predicting postoperative atrial fibrillation (AF) in patients undergoing surgery for esophageal carcinoma. METHODS:NT-proBNP levels were measured in 142 patients 24 h before and 1 h after surgery for esophageal carcinoma. All patients having a preoperative cardiac diagnosis by electrocardiogram (ECG), remained under continuous monitoring for at least 48 h after surgery, and then underwent clinical cardiac evaluation until discharge.RESULTS: Postoperative AF occurred in 11 patients (7.7%). AF patients were significantly older (69.6 ± 12.2 years vs 63.4 ± 13.3 years, P = 0.031) than non-AF patients. There were no significant differences in history of diabetes mellitus, sex distribution, surgical approach, anastomosis site, intraoperative hypotension and postoperative fever. The preoperative plasma NT-proBNP level was significantly higher in patients who developed postoperative AF (121.3 ± 18.3 pg/mL vs 396.1 ± 42.6 pg/mL, P = 0.016). After adjustment for age, gender, chronic obstructive pulmonary disease (COPD), history of cardiac diseases, hypertension, postoperative hypoxia and thoracic-gastric dilation, NT-proBNP levels were found to be associated with the highest risk factor for postoperative AF (odds ratio = 4.711, 95% CI = 1.212 to 7.644, P = 0.008).CONCLUSION: An elevated perioperative plasma BNP level is a strong and independent predictor of postoperative AF in patients undergoing surgery for esophageal carcinoma. This finding has important implications for identifying patients at higher risk of postoperative AF who should be considered for preventive antiarrhythmic therapy.

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“…12 Objective: N-terminal pro-B type natriuretic peptide (NT-pro-BNP) is one of the biomarkers, increased by myocardial ischemia or subsequent, burdened wall stress. The aim of this study was to assess if NT-pro-BNP can predict the incidence of atrial fibrillation (AF) after off-pump coronary artery bypass grafting (OPCAB).…”

Section: Original Articlementioning

confidence: 99%

Preoperative High N-Terminal pro-B-Type Natriuretic Peptide Level Can Predict the Incidence of Postoperative Atrial Fibrillation Following Off-Pump Coronary Artery Bypass Grafting

Matsuura

Mogi

Sakurai

et al. 2013

ATCS

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Objective: N-terminal pro-B type natriuretic peptide (NT-pro-BNP) is one of the biomarkers, increased by myocardial ischemia or subsequent, burdened wall stress. The aim of this study was to assess if NT-pro-BNP can predict the incidence of atrial fibrillation (AF) after off-pump coronary artery bypass grafting (OPCAB). Methods: NT-pro-BNP was measured preoperatively in 100 OPCAB patients without preoperative AF. Patients were divided into the AF group (n = 36) of those who developed postoperative AF, and the sinus rhythm (SR) group (n = 64), of those who did not. Odds ratio analysis was carried out with a logistic regression model using the threshold of the high quartile. Results: Age was more advanced in group AF (70.8 ± 8.7 years old) than in group SR (66.7 ± 8.5 years old), P = 0 025. There were more emergencies in group AF (22.2%) than in group SR (10.9%), P = 0 15. Preoperative NT-pro-BNP was significantly higher in group AF (509.6 ± 641.6 pg/mL) than in group SR (241.1 ± 302.7 pg/mL), P = 0 006. Preoperative administration of statins was relatively greater in group SR (73.4%) than in group AF (58.3%), P = 0 18. Four factors with a P value below 0.2 in the univariate analysis were extracted, which were preoperative administration of statins, emergency, high NT-pro-BNP (>348 pg/mL, high quartile), and advanced age (>75 years old, high quartile). The constructed logistic regression model revealed that high NT-pro-BNP (>348 pg/mL, high quartile) was the only predictor of postoperative AF after OPCAB (P = 0 05; OR, 2.60; 95% CI, 0.96-7.05). Conclusions: A high preoperative level of NT-pro-BNP could predict the incidence of postoperative AF after OPCAB.Keywords: coronary artery disease, outcomes, ischemic heart disease Objective: N-terminal pro-B type natriuretic peptide (NT-pro-BNP) is one of the biomarkers, increased by myocardial ischemia or subsequent, burdened wall stress. The aim of this study was to assess if NT-pro-BNP can predict the incidence of atrial fibrillation (AF) after off-pump coronary artery bypass grafting (OPCAB). Methods: NT-pro-BNP was measured preoperatively in 100 OPCAB patients without preoperative AF. Patients were divided into the AF group (n = 36) of those who developed postoperative AF, and the sinus rhythm (SR) group (n = 64), of those who did not. Odds ratio analysis was carried out with a logistic regression model using the threshold of the high quartile. Results: Age was more advanced in group AF (70.8 ± 8.7 years old) than in group SR (66.7 ± 8.5 years old), P = 0 025. There were more emergencies in group AF (22.2%) than in group SR (10.9%), P = 0 15. Preoperative NT-pro-BNP was significantly higher in group AF (509.6 ± 641.6 pg/mL) than in group SR (241.1 ± 302.7 pg/mL), P = 0 006. Preoperative administration of statins was relatively greater in group SR (73.4%) than in group AF (58.3%), P = 0 18. Four factors with a P value below 0.2 in the univariate analysis were extracted, which were preoperative administration of statins, emergency, high NT-pro-BNP (>348 pg/mL, high quar...

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Postoperative atrial fibrillation is a major cause of stroke after on-pump coronary artery bypass surgery

Cited by 186 publications

References 11 publications

Postoperative Atrial Fibrillation Is Not Associated With an Increase Risk of Stroke or the Type and Number of Grafts: A Single‐Center Retrospective Analysis

Postoperative Atrial Fibrillation Is Not Associated With an Increase Risk of Stroke or the Type and Number of Grafts: A Single‐Center Retrospective Analysis

Transrectal EUS-guided FNA biopsy of a presacral chordoma-report of a case and review of the literature

Preoperative High N-Terminal pro-B-Type Natriuretic Peptide Level Can Predict the Incidence of Postoperative Atrial Fibrillation Following Off-Pump Coronary Artery Bypass Grafting

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