Sex Differences in the Epidemiology of New-Onset In-Hospital Post–Coronary Artery Bypass Graft Surgery Atrial Fibrillation

Filardo, Giovanni; Ailawadi, Gorav; Pollock, Benjamin D.; Graca, Briget da; Sass, Danielle; Phan, Teresa K.; Montenegro, Debbie E.; Thourani, Vinod H.; Damiano, Ralph J.

doi:10.1161/circoutcomes.116.003023

Cited by 22 publications

(20 citation statements)

References 53 publications

(50 reference statements)

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“…Studies that included a higher proportion of males generally reported a higher risk of NOAF‐associated stroke, although this was a weakly significant interaction with a small effect. A recent study on the short‐term risk of NOAF‐related stroke determined that there was no significant association between sex and risk over this briefer time period …”

Section: Discussionmentioning

confidence: 97%

New‐Onset Atrial Fibrillation After Coronary Artery Bypass Graft and Long‐Term Risk of Stroke: A Meta‐Analysis

Megens

Чурилов

Thijs

2017

JAHA

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BackgroundNew‐onset atrial fibrillation (NOAF) after coronary artery bypass graft is related to an increased short‐term risk of stroke and mortality. We investigated whether the long‐term risk of stroke is increased.Methods and ResultsWe performed a systematic review and meta‐analysis of studies that included patients who had coronary artery bypass graft and who afterwards developed NOAF during their index admission; these patients did not have previous atrial fibrillation. The primary outcome was risk of stroke at 6 months or more in patients who developed NOAF compared with those who did not. Odds ratios, relative risk, and hazard ratios were considered equivalent; outcomes were pooled on the log‐ratio scale using a random‐effects model and reported as exponentiated effect‐sizes. We included 16 studies, comprising 108 711 participants with a median follow‐up period of 2.05 years. Average participant age was 66.8 years, with studies including an average of 74.8% males. There was an increased long‐term risk of stroke in the presence of NOAF (unadjusted studies effect‐sizes=1.36, 95% confidence interval, 1.12–1.65, P=0.001, adjusted studies effect‐sizes=1.25, 95% confidence interval, 1.09–1.42, P=0.001). There was evidence of moderate effect variation because of heterogeneity in studies reporting unadjusted (P=0.021, I2=49.8%) and adjusted data (P=0.081, I2=49.1%), and publication bias in the latter group (Egger's test, P=0.031). Sensitivity analysis on unadjusted data by study quality, design, and surgery did not alter the effect direction.ConclusionsPresence of NOAF in patients post–coronary artery bypass graft is associated with increased long‐term risk of stroke compared with patients without NOAF. Further studies may show whether the increased risk is mediated by atrial fibrillation and whether anticoagulation reduces risk.

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Section: Discussionmentioning

confidence: 97%

New‐Onset Atrial Fibrillation After Coronary Artery Bypass Graft and Long‐Term Risk of Stroke: A Meta‐Analysis

Megens

Чурилов

Thijs

2017

JAHA

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“…Large-sample data analysis also showed that men had a significantly higher risk of POAF. 1 , 2 , 3 , 4 , 5 …”

Section: Introductionmentioning

confidence: 99%

Association of Preoperative Renin-Angiotensin System Inhibitors With Prevention of Postoperative Atrial Fibrillation and Adverse Events

et al. 2019

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Key Points Question Does the use of renin-angiotensin system inhibitors have any association with reduction in atrial fibrillation and adverse events for patients undergoing cardiac surgery? Findings This systematic review and meta-analysis involving 11 unique studies with 27 885 patients undergoing cardiac surgery found no additional association between preoperative renin-angiotensin system inhibitor therapy and a reduced risk of postoperative atrial fibrillation, stroke, death, or hospitalization. Meaning The results provide no support for the routine use of renin-angiotensin system inhibitors for the possible prevention of postoperative atrial fibrillation and adverse events in patients undergoing cardiac surgery.

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“…Many studies have previously elucidated risk factors for postoperative AF, which include older age, previous history of atrial fibrillation, male sex, decreased left ventricular ejection fraction, left atrial enlargement, valve surgery, chronic obstructive pulmonary disease, chronic renal failure, diabetes mellitus, rheumatic heart disease, and obesity [Filardo 2016;Mathew 2004;Melby 2015]. Additionally, several studies have suggested that inflammation contributes to atrial fibrillation.…”

Section: Introductionmentioning

confidence: 99%

A A Novel Risk Score to Predict New Onset Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Grafting

Lin

Crawford

Suarez‐Pierre

et al. 2018

HSF

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Background: Atrial fibrillation (AF) is common after cardiac surgery and contributes to increased morbidity and mortality. Our objective was to derive and validate a predictive model for AF after CABG in patients, incorporating novel echocardiographic and laboratory values. Methods: We retrospectively reviewed patients at our institution without preexisting dysrhythmia who underwent on-pump, isolated CABG from 2011-2015. The primary outcome was new onset AF lasting >1 hour on continuous telemetry or requiring medical treatment. Patients with a preoperative echocardiographic measurement of left atrial diameter were included in a risk model, and were randomly divided into derivation (80%) and validation (20%) cohorts. The predictors of AF after CABG (PAFAC) score was derived from a multivariable logistic regression model by multiplying the adjusted odds ratios of significant risk factors (P < .05) by a factor of 4 to derive an integer point system. Results: 1307 patients underwent isolated CABG, including 762/1307 patients with a preoperative left atrial diameter measurement. 209/762 patients (27%) developed new onset AF including 165/611 (27%) in the derivation cohort. We identified four risk factors independently associated with postoperative AF which comprised the PAFAC score: age > 60 years (5 points), White race (5 points), baseline GFR < 90 mL/min (4 points) and left atrial diameter > 4.5 cm (4 points). Scores ranged from 0-18. The PAFAC score was then applied to the validation cohort and predicted incidence of AF strongly correlated with observed incidence (r = 0.92). Conclusion: The PAFAC score is easy to calculate and can be used upon ICU admission to reliably identify patients at high risk of developing AF after isolated CABG.

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Sex Differences in the Epidemiology of New-Onset In-Hospital Post–Coronary Artery Bypass Graft Surgery Atrial Fibrillation

Cited by 22 publications

References 53 publications

New‐Onset Atrial Fibrillation After Coronary Artery Bypass Graft and Long‐Term Risk of Stroke: A Meta‐Analysis

New‐Onset Atrial Fibrillation After Coronary Artery Bypass Graft and Long‐Term Risk of Stroke: A Meta‐Analysis

Association of Preoperative Renin-Angiotensin System Inhibitors With Prevention of Postoperative Atrial Fibrillation and Adverse Events

A A Novel Risk Score to Predict New Onset Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Grafting

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