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Atrial fibrillation after coronary artery bypass grafting in elderly patients: incidence and risk factor analysis
V Nisanoglu1, N Erdil, M Aldemir
1Department of Cardiovascular Surgery, Turgut Ozal Medical Center, Inonu University, Malatya, Turkey. vnisanoglu@inonu.edu.tr
Insights
New-onset atrial fibrillation (AF) after coronary artery bypass grafting (CABG) is common in elderly patients. Preoperative renal insufficiency and EuroSCORE are key predictors, aiding in prevention strategies.
Area of Science:
- Cardiology
- Geriatric Medicine
- Cardiac Surgery
Background:
- New-onset atrial fibrillation (AF) is the most frequent arrhythmic complication following coronary artery bypass grafting (CABG).
- Elderly patients (age ≥ 65 years) may present unique risk profiles for post-CABG AF.
Purpose of the Study:
- To identify independent clinical risk factors for post-CABG AF specifically within an elderly patient population.
Main Methods:
- A retrospective analysis of 426 elderly patients undergoing CABG between 2001 and 2005.
- Multivariate analysis was employed to determine predictors of AF occurrence, comparing patients who developed AF (n=91) with those who did not (n=335).
Main Results:
- The incidence of post-CABG AF in this elderly cohort was 21.4%.
- Independent predictors identified include increasing age, age ≥ 75 years, preoperative renal insufficiency, EuroSCORE, and prolonged cross-clamping time.
- Patients with post-CABG AF experienced longer intensive care unit (ICU) stays.
Conclusions:
- Preoperative renal insufficiency and EuroSCORE emerged as significant novel predictors of post-CABG AF in the elderly.
- Identifying these risk factors is crucial for developing targeted prevention strategies to mitigate AF complications after CABG.
Objective:
New-onset atrial fibrillation (AF) is the most frequent arrhythmic complication after coronary artery bypass grafting (CABG). Elderly patients who undergo this operation may have a different risk profile from the general population. The aim of this study was to identify risk factors for post-CABG AF in the elderly population.
Methods:
Between September 2001 and December 2005, 426 elderly patients (age >/= 65 years) underwent CABG at our center. Ninety-one developed post-CABG AF (AF group), and the other 335 (no-AF group) did not develop this complication. Multivariate analysis (odds ratio, +/- 95 % CI, P value) was used to identify independent clinical predictors of post-CABG AF.
Results:
The incidence of post-CABG AF in elderly patients during the study period was 21.4 %. Multivariate analysis identified age (OR 1.07, P < 0.009), age >/= 75 years (OR 1.77, P < 0.042), preoperative renal insufficiency (OR 5.09, P < 0.035), EuroSCORE (OR 1.18, P < 0.038), and cross-clamping time (OR 1.02, P < 0.012) as predictors of AF occurrence. The AF group had a significantly longer mean intensive care unit (ICU) stay (3.8 +/- 4.7 vs. 2.5 +/- 1.3 days for AF vs. no-AF; P = 0.0001), and a significantly higher proportion of patients with prolonged (>/= 6 days) ICU stays (8.8 % vs. 3.2 %, respectively; P = 0.033). Hospital mortality was 3.2 % in the no-AF group and 2.2 % in the AF group ( P = 0.74).
Conclusion:
This study of elderly patients reveals some novel predictors of post-CABG AF, most notably preoperative renal insufficiency and EuroSCORE. It is important to identify risk factors for post-CABG AF in all patient groups as this knowledge might lead to better prevention of this problem and its potential consequences.
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