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Postoperative atrial fibrillation and mortality after coronary artery bypass surgery.

Abstract：

OBJECTIVES:We sought to determine if the occurrence of postoperative atrial fibrillation (AF) affects early or late mortality following coronary artery bypass surgery (CABG). BACKGROUND:Atrial fibrillation is the most common arrhythmia seen following CABG. METHODS:The Texas Heart Institute Cardiovascular Research Database was used to identify all patients that developed AF after isolated initial CABG from January 1993 to December 1999 (n = 994). This population was compared with patients who underwent CABG during the same period but did not develop AF (n = 5,481). In-hospital end points were adjusted using logistic regression models to account for baseline differences. Long-term survival was evaluated using a retrospective cohort design, where Cox proportional hazards methods were used to adjust for baseline differences, and with case-matched populations (n = 390, 195 per arm). RESULTS:Atrial fibrillation was diagnosed in 16% of the population. Postoperative AF was associated with greater in-hospital mortality (odds ratio [OR] 1.7, p = 0.0001), more strokes (OR 2.02, p = 0.001), prolonged hospital stays (14 vs. 10 days, p < 0.0001), and a reduced incidence of myocardial infarction (OR 0.62, p = 0.01). At four to five years, survival was worse in patients who developed postoperative AF (74% vs. 87%, p < 0.0001 in the retrospective cohort; 80% vs. 93%, p = 0.003 in the case-matched population). On multivariate analysis, postoperative AF was an independent predictor of long-term mortality (adjusted OR 1.5, p < 0.001 in the retrospective cohort; OR 3.4, p = 0.0018 in the case-matched population). CONCLUSIONS:The occurrence of AF following CABG identifies a subset of patients who have a reduced survival probability following CABG. The impact of various strategies, such as antiarrhythmics and warfarin, aimed at reducing AF and its complications deserves further study.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Villareal RP,Hariharan R,Liu BC,Kar B,Lee VV,Elayda M,Lopez JA,Rasekh A,Wilson JM,Massumi A

doi

10.1016/j.jacc.2003.11.023

subject

Has Abstract

pub_date

2004-03-03 00:00:00

pages

742-8

issue

eissn

0735-1097

issn

1558-3597

pii

S0735109703016243

journal_volume

pub_type

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Postoperative atrial fibrillation and mortality after coronary artery bypass surgery.