Statins Reduce Short‐ and Long‐Term Mortality Associated With Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting: Impact of Postoperative Atrial Fibrillation and Statin Therapy on Survival

Abstract

Background:Postoperative atrial fibrillation (POAF) is a frequent complication of coronary artery bypass grafting (CABG) surgery. The objective of this study was to determine the impact of POAF on both short‐ and long‐term mortality following isolated CABG.Hypothesis:POAF is associated with a poorer short and long‐term mortality following CABG.Methods:We retrospectively analyzed the preoperative and operative data of 6728 consecutive patients undergoing a first isolated CABG.Results:The incidence of POAF was 27.8%. Operative mortality was higher in patients with POAF compared to those without POAF (2.3% vs 0.9%, P < 0.001). On multivariate analysis, POAF remained an independent predictor of operative mortality (odds ratio [OR]: 1.78, P = 0.01). Patients with POAF also had reduced long‐term survival (6‐year survival: 85.3% vs 89.2%, P < 0.001). After adjusting for other predictors of mortality, POAF was significantly associated with increased long‐term mortality (hazard ratio [HR]: 1.35, P = 0.04). Of note, after adjustment for potential confounders, statin treatment had a highly protective effect in POAF patients for both operative mortality (OR: 0.38, P = 0.003) and long‐term mortality (HR: 0.62, P = 0.03), whereas it had no significant effect in patients without POAF.Conclusions:POAF is an independent predictor of both short‐ and long‐term mortality following CABG. Moreover, statin therapy was independently associated with better survival in patients with POAF.Dr. Pibarot holds the Canada Research Chair in Valvular Heart Diseases, Canadian Institutes of Health Research. Dr. Mathieu is a research scholar from the Fonds de Recherches en Santé du Québec, Montreal, Canada. Dr. Després has served as a speaker for Abbott Laboratories, AstraZeneca, Solvay Pharma, GlaxoSmithKline, and Pfizer Canada Inc.; has received research funding from Eli Lilly Canada; and has served on the advisory boards of Novartis, Theratechnologies, Torrent Pharmaceuticals Ltd., and Sanofi‐Aventis. The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Predictors of in-hospital mortality following redo cardiac surgery: Single center experience

“…In high-risk patients with complex coronary artery disease (i.e., Euro SCORE >5), CABG is superior to other coronary re vascularization procedures. AF after cardiac surgery occurs in approximately one third of patients and is associated with an increase in adverse events and inhospital mortality [17]. Our results determined that AF is a predictor of hospital mortality after cardiac reoperations as well.…”

New‐onset atrial fibrillation and outcomes following isolated coronary artery bypass surgery: A systematic review and meta‐analysis

“…Short-term stroke rates were reported in three studies and showed increased stroke rate in the group with NOAF. 12,16,17 The majority of studies reported stroke at greater than 1 year of follow-up. There were equivocal results for long-term stroke rates, with rates in the group with NOAF ranging from similar to the group without AF 8,9,11,18 to higher than the group without AF.…”

“…12,13,16,19,23 In six of the other studies, either there was no significant difference in the history of stroke in the NOAF group compared to the group without AF, 10,15 or adjusted outcomes or matched groups were used. 14,17,21,22 It is likely that the unadjusted outcomes were affected by prior history of stroke. However, the association of NOAF with stroke and mortality was found even in the meta-analysis of adjusted outcomes, indicating that NOAF is likely an independent risk factor.…”

Use of statins and adverse outcomes in patients with atrial fibrillation: An analysis from the EURObservational Research Programme Atrial Fibrillation (EORP-AF) general registry pilot phase

“…Interestingly, our data are consistent with previous evidence from patients post-coronary artery by-pass graft surgery with AF whereby statins resulted in reductions of both short-and long-term mortality. [37] Our data showed a reduction in risk of major adverse events associated to the use of statin, perhaps even stronger than most of the interventional trials testing statins. Also, considering that patients using statins reported a higher prevalence of most comorbidities, we could hypothesize that the strong reduction in risk could be partially explained by a stronger treatment intensity and/or more intensive risk factorsmanagement, eventhough the multivariate analysis did consider the most relevant risk factors and the main cardioprotective pharmacological treatments.…”