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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
New-onset atrial fibrillation predicts long-term mortality after coronary artery bypass graft
Mikhael F El-Chami1, Patrick Kilgo, Vinod Thourani
1Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia 30308, USA. melcham@emory.edu
Insights
New-onset atrial fibrillation after coronary artery bypass graft surgery (POAF) independently predicts long-term mortality. Warfarin therapy may improve survival for patients experiencing POAF.
Area of Science:
- Cardiology
- Cardiac Surgery
- Clinical Outcomes Research
Background:
- Post-operative atrial fibrillation (POAF) following coronary artery bypass graft (CABG) surgery is associated with increased hospital stay and mortality.
- Understanding the long-term prognostic implications of new-onset POAF is crucial for patient management.
Purpose of the Study:
- To investigate the association between new-onset post-operative atrial fibrillation (POAF) and long-term mortality in patients without a prior history of atrial fibrillation.
- To evaluate the impact of warfarin therapy on survival in patients who develop POAF.
Main Methods:
- A retrospective analysis of 16,169 patients undergoing isolated CABG between 1996 and 2007.
- Multivariable Cox proportional hazards regression was used to assess the independent effect of POAF on long-term mortality, adjusting for numerous clinical covariates and post-operative events.
- All-cause mortality data were obtained from Social Security Administration death records.
Main Results:
- New-onset POAF occurred in 18.5% of patients undergoing CABG.
- POAF was an independent predictor of long-term mortality (HR: 1.21; 95% CI: 1.12-1.32) over a mean follow-up of 6 years.
- Warfarin use in patients discharged with POAF was associated with reduced long-term mortality.
Conclusions:
- New-onset POAF following CABG is a significant independent predictor of long-term mortality.
- Warfarin anticoagulation may offer survival benefits for patients who develop POAF after CABG.
Objectives:
We sought to investigate the association between new-onset atrial fibrillation after coronary artery bypass graft (CABG) (post-operative atrial fibrillation [POAF]) and long-term mortality in patients with no history of atrial fibrillation.
Background:
POAF predicts longer hospital stay and greater post-operative mortality.
Methods:
A total of 16,169 consecutive patients with no history of AF who underwent isolated CABG at our institution between January 1, 1996, and December 31, 2007, were included in the study. All-cause mortality data were obtained from Social Security Administration death records. A multivariable Cox proportional hazards regression model was constructed to determine the independent impact of new-onset POAF on long-term survival after adjusting for several covariates. The covariates included age, sex, race, pre-operative risk factors (ejection fraction, New York Heart Association functional class, history of myocardial infarction, index myocardial infarction, stroke, chronic obstructive pulmonary disease, peripheral arterial disease, smoking, diabetes, renal failure, hypertension, dyslipidemia, creatinine level, dialysis, redo surgery, elective versus emergent CABG, any valvular disorder) and post-operative adverse events (stroke, myocardial infarction, acute respiratory distress syndrome, and renal failure), and discharge cardiac medications known to affect survival in patients with coronary disease.
Results:
New-onset AF occurred in 2,985 (18.5%) patients undergoing CABG. POAF independently predicted long-term mortality (hazard ratio: 1.21; 95% confidence interval: 1.12 to 1.32) during a mean follow-up of 6 years (range 0 to 12.5 years). This association remained true after excluding from the analysis those patients who died in-hospital after surgery (hazard ratio: 1.21; 95% confidence interval: 1.11 to 1.32). Patients with POAF discharged on warfarin experienced reduced mortality during follow-up.
Conclusions:
In this large cohort of patients, POAF predicted long-term mortality. Warfarin anticoagulation may improve survival in POAF.
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