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Transient post-operative atrial fibrillation predicts short and long term adverse events following CABG
Femi Philip1, Matthew Becker1, John Galla1
1Sones Cardiac Catheterization Laboratory, Cleveland Clinic, Cleveland, Ohio 441195, USA.
Insights
Transient post-operative atrial fibrillation (TPOAF) after coronary artery bypass graft (CABG) surgery significantly increases the risk of long-term mortality. Identifying TPOAF is crucial for risk stratification in CABG patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Atrial fibrillation (AF) post-coronary artery bypass graft (CABG) surgery is common, impacting perioperative outcomes.
- The long-term effects of transient post-operative atrial fibrillation (TPOAF) after first-time, isolated CABG remain unclear.
Purpose of the Study:
- To evaluate the association between TPOAF following CABG and long-term mortality risk.
- To determine if TPOAF predicts adverse outcomes in patients undergoing CABG.
Main Methods:
- Retrospective analysis of 5,205 patients undergoing CABG from January 1993 to December 2005.
- Comparison of patients with TPOAF (n=1,490) versus those without (n=3,645) for 1-year mortality, myocardial infarction (MI), and stroke.
- Multivariate analysis and propensity matching to assess independent predictors of mortality.
Main Results:
- 1-year mortality, MI, and stroke rates were 3.7%, 0.8%, and 2.6%, respectively.
- Patients with TPOAF exhibited a higher 1-year mortality risk (6.4% vs. 2.7%, P<0.001) but not increased stroke or MI risk.
- TPOAF was an independent predictor of 1-year death (HR 1.89) and remained significant after propensity matching (HR 1.96).
Conclusions:
- TPOAF in first-time, isolated CABG patients identifies a subgroup at elevated risk for all-cause mortality.
- Further prospective research is needed to explore interventions for TPOAF patients.
- TPOAF is a significant marker for increased long-term mortality post-CABG.
Objective:
To assess the relationship between the development of transient post-operative atrial fibrillation (TPOAF) following coronary artery bypass graft (CABG) surgery and risk of long-term mortality.
Background:
Atrial fibrillation (AF) following CABG is common and associated with increased morbidity and mortality in the perioperative period. However the impact of TPOAF and its management on long-term morbidity and mortality in patients undergoing first time, isolated CABG surgery remains unclear.
Methods:
The Cleveland Clinic Cardiovascular Information Registry was used to identify 5,205 consecutive patients who underwent CABG between January 1993 and December 2005. Patients with TPOAF (n=1,490) were compared to those without post-operative AF (n=3,645) for the endpoints of death, myocardial infarction (MI), or stroke at 1 year.
Results:
Overall rates of 1-year mortality, MI and stroke were 3.7%, 0.8%, and 2.6%, respectively. Patients with TPOAF had an increased risk of death at 1 year as compared to patients without POAF (6.4% vs. 2.7%; P<0.001), but there was not an increased risk of stroke or MI. Multivariate analysis identified TPOAF as an independent predictor of death at 1 year (HR 1.89, 95% CI, 1.42-2.53; P<0.001). After propensity matching, patients who developed TPOAF experienced a significantly increased risk of death compared with those without TPOAF (HR 1.96, 95% CI, 1.34-2.86; P<0.001).
Conclusions:
In patients undergoing first time, isolated CABG, the presence of TPOAF identifies a subgroup of patients at increased risk for all-cause mortality. Future prospective studies to determine potential beneficial interventions in this large population are warranted.
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