Preoperative atrial fibrillation portends poor outcomes after coronary bypass graft surgery: A systematic review and meta-analysis

Abstract

Supplemental material is available online.Video clip is available online. Atrial fibrillation (AF) is the most common abnormal cardiac rhythm, with an estimated prevalence of 4% in the Australian population older than the age of 30 years. 1 The incidence of AF steadily increases with age; the prevalence in those older than 80 years is up to 15%. 2 The loss of coordinated atrial activity by AF predisposes patients to thrombus formation and, subsequently, embolic stroke. 3 Moreover, chronic AF has been associated with a 2-fold increase in the risk of premature death. 3 The demographic profile of patients undergoing coronary artery bypass graft (CABG) surgery has significantly changed in the past 2 decades as the result of an increased use of coronary stents and the aging population of developed countries. Increasingly, older patients with a greater incidence of comorbidities including valvular disease, diabetes, and impaired ventricular function are undergoing CABG. [4][5][6] These factors are all associated with an increased risk of AF. 7 Hence, it is imperative to understand the clinical implications of preoperative atrial fibrillation (preAF) for patients undergoing CABG. Some cohort studies have demonstrated that preAF may be an independent risk factor for poorer perioperative outcomes and reduced long-term survival. [8][9][10][11][12] However, there has only been a limited evaluation of preAF in the context of CABG surgery, and the EuroSCORE has not recognized preAF as a risk modifier. Moreover, the impact of preAF on clinical outcomes according to revascularization strategy (on-pump or off-pump CABG) remains largely unexplored.The primary aim of this of this meta-analysis was to evaluate the impact of preAF on short-and long-term outcomes after CABG surgery. As a secondary outcome, the impact of preAF on clinical outcomes depending on revascularization strategy (on-pump vs off-pump) was explored. Our hypothesis is that preAF has a negative impact on early and late outcomes after CABG surgery. METHODSThis systematic review and meta-analysis was conducted and presented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. 13 The study was approved by the local ethics committee. Search Strategy and Study SelectionElectronic searches were performed with Ovid Medline, Embase, and Cochrane Central Register of Controlled Trials from their dates of inception to January 2016. The search terms ''coronary artery bypass'' From the Departments of

Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association

“…Individuals with other cardiovascular conditions and procedures, including HCM, 207 MI, 208 pre-CABG, 209 post-CABG 208,210,211 (both short term 210 and long term 210,211 ), post–transcatheter aortic valve implantation, 212 PAD, 213 and stroke. 214…”

“…AF is also associated with increased mortality in subgroups of individuals, including the following: Individuals with other cardiovascular conditions and procedures, including HCM, 207 MI, 208 pre-CABG, 209 post-CABG 208,210,211 (both short term 210 and long term 210,211 ), post–transcatheter aortic valve implantation, 212 PAD, 213 and stroke. 214 Individuals with AF have increased mortality with concomitant HF, 215 including HFpEF 216 and HFrEF.…”

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association

“…AF is also associated with increased mortality in subgroups of individuals, including the following: Individuals with other cardiovascular conditions and procedures, including HCM, 198,199 MI, 200 pre-CABG, 201 post-CABG 200,202,203 (both short term 202 and long term 202,203 ), post–transcatheter aortic valve implantation, 204 PAD, 205 and stroke. 206 Individuals with AF have increased mortality with concomitant HF, 207 including HFpEF 208 and HFrEF.…”

“…Individuals with other cardiovascular conditions and procedures, including HCM, 198,199 MI, 200 pre-CABG, 201 post-CABG 200,202,203 (both short term 202 and long term 202,203 ), post–transcatheter aortic valve implantation, 204 PAD, 205 and stroke. 206…”

Atrial Fibrillation and Mitral Valve Prolapse

“…(8) In patients undergoing various types of cardiac surgery, pre-existing AF is associated with reduced postoperative survival. (9,10) It is currently unknown, however, if earlier surgical intervention prior to or shortly after the development of AF leads to improved outcomes. This is an important distinction, since a curative surgical therapy – namely mitral valve (MV) repair surgery – exists for patients with DMR.…”