Increased late mortality after coronary artery bypass surgery complicated by isolated new-onset atrial fibrillation: a comprehensive propensity-matched analysis
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Laila Al-Shaar1, Thomas A Schwann2, Ameer Kabour3
1Vascular Medicine Program, American University of Beirut, Beirut, Lebanon.
Insights
New-onset postoperative atrial fibrillation (POAF) increases late mortality after coronary artery bypass grafting (CABG). Reducing POAF may improve patient outcomes and reduce healthcare costs.
Area of Science:
- Cardiovascular Surgery
- Cardiac Electrophysiology
- Outcomes Research
Background:
- Postoperative atrial fibrillation (POAF) is a common complication after coronary artery bypass grafting (CABG).
- The independent effect of POAF on long-term mortality is often obscured by other serious perioperative complications.
- Understanding the isolated impact of POAF is crucial for developing targeted interventions.
Purpose of the Study:
- To determine the independent association between new-onset POAF and late mortality after CABG.
- To quantify the time-dependent nature of this association.
- To account for confounding factors including comorbidities and perioperative events.
Main Methods:
- A cohort of 6305 patients undergoing non-salvage CABG without prior AF or concomitant valve/aortic surgery was analyzed.
- Patients were divided into groups with and without POAF, with propensity matching performed on 55 variables.
- Time-segmented Cox regression analysis was used to assess the hazard ratios for mortality.
Main Results:
- Propensity matching created comparable cohorts for analysis.
- Patients experiencing POAF demonstrated a time-varying increase in mortality risk over 18 years post-CABG.
- Hazard ratios for mortality were elevated in the POAF group during different time intervals (1-6 years and 6-17 years).
Conclusions:
- Isolated POAF is independently associated with increased long-term mortality following CABG.
- Strategies aimed at reducing the incidence of POAF are warranted.
- Mitigating POAF could lead to improved patient survival, reduced morbidity, and better resource utilization.
Objectives:
The association of new-onset postoperative atrial fibrillation (POAF) and late death after coronary artery bypass grafting (CABG) has been confounded by the frequent concomitant serious complications that co-occur with POAF. We aimed to define the magnitude and time dependence of the effect of isolated POAF on late survival after uncomplicated CABG to comprehensively account for comorbidity and perioperative confounding factors.
Methods:
Nonsalvage CABG patients with no history of AF, no concomitant aortic or valvular surgery, and no perioperative complications other than POAF were studied (n=6305). Patients were divided into AF (n=1211, 68 years old, 72% male) and no-AF (n=5094, 63 years old, 70% male) groups. Propensity matching was done using 55 patient variables, including coronary grafts, completeness of revascularization, and transfusion data. The AF effect was quantified using time-segmented hazard ratios by Cox regression analysis.
Results:
Single (1-to-1), double (1-to-2), and triple (1-to-3) propensity matching of the AF and no-AF was achieved for 1196, 993, and 719 cases, respectively. The AF group showed significantly worse, yet time-varying, 0- to 18-year survival: 0 to 1 year, HR, 1.18 (95% confidence interval, 0.77-1.81); 1 to 6 years, HR, 1.37 (95% confidence interval, 1.12 to 1.67); and 6 to 17 years, HR, 1.25 (95% confidence interval, 1.05 to 1.49).
Conclusions:
Isolated POAF was associated with a time-varying increase in mortality after CABG. Given these findings and the high incidence of POAF, efforts to reduce POAF should be pursued to potentially improve resource usage, morbidity, and mortality.
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