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Published on: February 26, 2013
Atrial fibrillation after isolated coronary surgery affects late survival
Giovanni Mariscalco1, Catherine Klersy, Marco Zanobini
1Department of Surgical Sciences, Cardiac Surgery Division, Varese University Hospital, I-21100 Varese, Italy. giovannimariscalco@yahoo.it
Insights
Postoperative atrial fibrillation (AF) after coronary artery bypass graft surgery significantly increases early and late mortality. Patients with AF face a higher risk of fatal embolic events, necessitating vigilant monitoring and preventative strategies.
Area of Science:
- Cardiology
- Cardiac Surgery
- Clinical Outcomes Research
Background:
- Postoperative atrial fibrillation (AF) following coronary artery bypass graft (CABG) surgery is a significant clinical challenge, contributing to patient morbidity and mortality.
- The precise prognostic implications of AF after CABG remain a subject of ongoing research and clinical debate.
Purpose of the Study:
- To investigate the impact of postoperative AF on survival rates after isolated CABG.
- To evaluate the prognostic significance of AF concerning cause-specific mortality in the postoperative period.
Main Methods:
- A prospective observational study involving 1832 patients undergoing isolated CABG between 2000 and 2005.
- Follow-up until April 2007 to assess mortality, with a median follow-up of 51 months.
- Cox regression analysis was employed to determine adjusted hazard ratios for mortality, considering factors like warfarin use.
Main Results:
- 31% of patients (570) developed postoperative AF, experiencing longer hospital stays and higher in-hospital mortality (3.3% vs. 0.5%).
- Long-term mortality was substantially higher in patients with AF (2.99 per 100 person-years) compared to those without (1.34 per 100 person-years), with an adjusted hazard ratio of 2.13.
- Patients with AF demonstrated a significantly increased risk of death from embolism (adjusted hazard ratio, 4.33).
Conclusions:
- Postoperative AF adversely affects both early and late mortality following isolated CABG.
- AF increases the risk of fatal embolic events, underscoring the need for targeted interventions.
- Recommendations include careful postoperative surveillance and proactive antiarrhythmic and antithrombotic prophylaxis to mitigate AF-related complications.
Background:
Atrial fibrillation (AF) after coronary artery bypass graft surgery is a difficult problem and a continuing source of morbidity and mortality. However, the prognostic implications of postoperative AF are still in dispute. Our aim was to ascertain the impact of AF after coronary artery bypass graft on postoperative survival and to assess its prognostic role in cause-specific mortality.
Methods And Results:
We conducted a prospective observational study of 1832 patients undergoing isolated coronary artery bypass graft between January 2000 and December 2005 at 2 cardiac surgery centers in northern Italy. Patients affected by postoperative AF were identified and followed up until death or study end (April 30, 2007). A total of 570 patients (31%) developed AF after coronary surgery. Patients affected by postoperative AF experienced a longer hospital stay (7 days [25th to 75th percentile, 7 to 10 days] versus 7 days [25th to 75th percentile, 6 to 8 days]; P<0.001). Hospital mortality also was higher in AF patients (3.3% versus 0.5%; P<0.001). On discharge, 1806 patients were alive; 143 were lost to follow-up. The remaining 1663 were followed up for a median of 51 months (25th to 75th percentile, 41 to 63 months); 126 of them died after a median of 14 months (25th to 75th percentile, 5 to 32 months). Long-term mortality rates were significantly higher for patients with postoperative AF (2.99 per 100 person-years; 95% confidence interval, 2.33 to 3.84; 61 deaths) compared with those without the arrhythmia (1.34 per 100 person-years; 95% confidence interval, 1.05 to 1.71; 65 deaths), with an adjusted hazard ratio of 2.13 (P<0.001) and 2.56 (P=0.001) when also accounting for the prescription of warfarin at discharge. With Cox regression, patients with AF were shown to be at higher risk of dying from embolism (adjusted hazard ratio, 4.33; 95% confidence interval, 1.78 to 10.52) but not from other causes.
Conclusions:
Postoperative AF affects early and late mortality after isolated coronary artery bypass graft surgery. Patients affected by AF are at higher risk of fatal embolic events. Careful postoperative surveillance with a specific antiarrhythmic and antithrombotic prophylaxis, aimed at reducing AF and its complications, is recommended.
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