Abstract:
BACKGROUND:Current practice related to the management of atrial fibrillation (AF) complicating coronary artery bypass grafting (CABG) is uncertain. METHODS:We examined management of post-CABG AF in the PREVENT-IV trial, and we explored patterns of use of postoperative rhythm versus rate control and anticoagulation for AF by geographic region and type of site. We also compared outcomes of patients who developed post-CABG AF (663) with those who did not (2,131). RESULTS:The incidence of AF was 24%. Post-CABG AF was treated with a rhythm control strategy in 81% of patients and with warfarin in 23% of patients. Although there were significant variations across sites in the management of post-CABG AF, patterns of use of postoperative rhythm versus rate control and anticoagulation did not differ by geographic region or by whether or not the enrolling site was an academic institution. Mortality was higher in patients with post-CABG AF than patients without AF at 30 days (1.5% vs 0.7%, P = .01) but not at 3 years (6.9% vs 4.9%, P = .41). There was a trend toward a higher risk of mortality or stroke at 30 days in patients with AF (2.4% vs 1.9%, P = .08). CONCLUSION:Although a rhythm control strategy was used in most of the patients in this trial and the overall rate of use of warfarin was low, the significance of these findings is uncertain because of the lack of data from randomized clinical trials. The substantial variations in the management of post-CABG AF across sites are likely because of definitive data on the most effective therapies, highlighting the need for clinical trials on rate versus rhythm control and on anticoagulation for AF in this setting.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Al-Khatib SM,Hafley G,Harrington RA,Mack MJ,Ferguson TB,Peterson ED,Califf RM,Kouchoukos NT,Alexander JHdoi
10.1016/j.ahj.2009.09.003subject
Has Abstractpub_date
2009-11-01 00:00:00pages
792-8issue
5eissn
0002-8703issn
1097-6744pii
S0002-8703(09)00720-0journal_volume
158pub_type
杂志文章,随机对照试验abstract::Although it has been shown that early cardiac rejection can be visualized by radioimmunoscintigraphy targeting major histocompatibility complex class II antigen, the use of antibodies that bind to a polymorphic determinant of class II antigen has certain disadvantages for clinical application. This investigation was d...
journal_title:American heart journal
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abstract::We studied 56 right ventricular papillary muscles isolated from cats to determine whether the direct mechanical effects of contrast media are due to their pharmacologic action or to the hyperosmolality caused by them. A 10% solution of Renografin-76 abruptly decreased force 22% below control, then slowly increased it ...
journal_title:American heart journal
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abstract:BACKGROUND:Protease-activated receptor 1 antagonism with vorapaxar represents a novel strategy for platelet inhibition. In TRACER, vorapaxar was compared with placebo plus standard of care among 12,944 patients with non-ST-segment elevation acute coronary syndromes. We anticipated that most patients would have received...
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pub_type: 杂志文章
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pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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pub_type: 杂志文章
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pub_type: 杂志文章,多中心研究
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pub_type: 临床试验,杂志文章
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pub_type: 杂志文章
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journal_title:American heart journal
pub_type: 杂志文章
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pub_type: 杂志文章
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pub_type: 杂志文章
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journal_title:American heart journal
pub_type: 杂志文章
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pub_type: 杂志文章,meta分析,评审
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