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Published on: February 26, 2013
Preoperative atrial fibrillation decreases event-free survival following cardiac surgery
Dimitri Kalavrouziotis1, Karen J Buth, Tarren Vyas
1Department of Surgery, Division of Cardiac Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Centre, 1796 Summer Street, Room 2269, Halifax, Nova Scotia, Canada, B3H 3A7.
Insights
Preoperative atrial fibrillation (AF) increases risks for cardiac surgery patients, leading to worse long-term survival and more cardiovascular events. Management strategies for AF require further exploration to improve patient outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Preoperative atrial fibrillation (AF) is a common comorbidity in patients undergoing cardiac surgery.
- The impact of preoperative AF on both short-term and long-term outcomes after cardiac surgery remains a significant clinical concern.
Purpose of the Study:
- To investigate the association between preoperative atrial fibrillation and early clinical outcomes.
- To determine the relationship between preoperative atrial fibrillation and late clinical outcomes, including mortality and cardiovascular re-hospitalization, following cardiac surgery.
Main Methods:
- A retrospective cohort study included 9796 patients undergoing coronary artery bypass graft and/or valve surgery between 1995 and 2005.
- In-hospital outcomes were analyzed, and late outcomes were assessed via administrative health databases with a median follow-up of 2.9 years.
- No patients underwent concomitant surgical AF ablation.
Main Results:
- Prevalence of preoperative AF was 11.3%, varying by surgical procedure.
- Patients with preoperative AF experienced higher rates of in-hospital mortality, stroke, and renal failure.
- Longitudinal analysis revealed that preoperative AF was significantly associated with decreased event-free survival (aHR 1.55, p < 0.0001).
Conclusions:
- Preoperative atrial fibrillation is linked to increased late mortality and recurrent cardiovascular events after cardiac surgery.
- Developing effective management strategies for preoperative AF is crucial for improving long-term outcomes in cardiac surgical patients.
Objective:
To investigate the relationship between preoperative atrial fibrillation and early and late clinical outcomes following cardiac surgery.
Methods:
A retrospective cohort including all consecutive coronary artery bypass graft and/or valve surgery patients between 1995 and 2005 was identified (n = 9796). No patient had a concomitant surgical AF ablation. The association between preoperative atrial fibrillation and in-hospital outcomes was examined. We also determined late death and cardiovascular-related re-hospitalization by linking to administrative health databases. Median follow-up was 2.9 years (maximum 11 years).
Results:
The prevalence of preoperative atrial fibrillation was 11.3% (n = 1105), ranging from 7.2% in isolated CABG to 30% in valve surgery. In-hospital mortality, stroke, and renal failure were more common in atrial fibrillation patients (all p < 0.0001), although the association between atrial fibrillation and mortality was not statistically significant in multivariate logistic regression. Longitudinal analyses showed that preoperative atrial fibrillation was associated with decreased event-free survival (adjusted hazard ratio 1.55, 95% confidence interval 1.42-1.70, p < 0.0001).
Conclusions:
Preoperative atrial fibrillation is associated with increased late mortality and recurrent cardiovascular events post-cardiac surgery. Effective management strategies for atrial fibrillation need to be explored and may provide an opportunity to improve the long-term outcomes of cardiac surgical patients.
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