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Published on: February 26, 2013
Atrial fibrillation following cardiac surgery: risk analysis and long-term survival
Solveig Helgadottir1, Martin I Sigurdsson, Inga L Ingvarsdottir
1Departments of Cardiothoracic Surgery, University of Iceland, Reykjavik, Iceland.
Insights
Postoperative atrial fibrillation (POAF) affects 44% of open-heart surgery patients, increasing complications and mortality. Identifying high-risk individuals through a new risk-assessment model can improve outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Epidemiology
Background:
- Postoperative atrial fibrillation (POAF) is a common complication following open-heart surgery.
- Risk factors and outcomes associated with POAF require further investigation.
Purpose of the Study:
- To identify risk factors for POAF in patients undergoing cardiac surgery.
- To evaluate the short- and long-term outcomes of patients with POAF.
- To develop a predictive risk-assessment model for POAF.
Main Methods:
- Retrospective study of 744 patients undergoing CABG, OPCAB, or AVR.
- Logistic regression analysis to determine independent risk factors for POAF.
- Comparison of clinical characteristics and outcomes between patients with and without POAF.
Main Results:
- POAF occurred in 44% of patients, with higher rates after AVR (74%) compared to CABG (44%) and OPCAB (35%).
- Independent predictors of POAF included AVR, preoperative cardiac failure, higher EuroSCORE, and advanced age.
- POAF was associated with longer hospital stay, increased complications, higher operative mortality, and reduced five-year survival.
Conclusions:
- The incidence of POAF in this cohort was 44%, higher than reported in some previous studies.
- A novel risk-assessment score may help identify high-risk patients for POAF.
- Early identification and management of POAF can potentially reduce associated complications.
Background:
We studied potential risk factors for postoperative atrial fibrillation (POAF) in a large cohort of patients who underwent open-heart surgery, evaluating short- and long-term outcome, and we developed a risk-assessment model of POAF.
Methods:
A retrospective study of 744 patients without prior history of AF who underwent CABG (n = 513), OPCAB (n = 207), and/or AVR (n = 156) at Landspitali Hospital in 2002-2006. Logistic regression analysis was used to study risk factors for POAF, comparing patients with and without POAF.
Results:
The rate of POAF was 44%, and was higher following AVR (74%) than after CABG (44%) or OPCAB (35%). In general, patients with POAF were significantly older, were more often female, were less likely to be smokers, had a lower EF, and had a higher EuroSCORE. The use of antiarrythmics was similar in the groups but patients who experienced POAF were less likely to be taking statins. POAF patients also had longer hospital stay, higher rates of complications, and operative mortality (5% vs. 0.7%). In multivariate analysis, AVR (OR 4.4), a preoperative history of cardiac failure (OR 1.8), higher EuroSCORE (OR 1.1), and advanced age (OR 1.1) were independent prognostic factors for POAF. Overall five-year survival was 83% and 93% for patients with and without POAF (p <0.001).
Conclusion:
POAF was detected in 44% of patients, which is high compared to other studies. In the future, our assessment score will hopefully be of use in identifying patients at high risk of POAF and lower complications related to POAF.
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