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Published on: February 26, 2013
Sex Differences in the Epidemiology of New-Onset In-Hospital Post-Coronary Artery Bypass Graft Surgery Atrial
Giovanni Filardo1, Gorav Ailawadi2, Benjamin D Pollock2
1From the Office of the Chief Quality Officer, Baylor Scott & White Health, Dallas, TX (G.F., B.D.P., B.d.G., D.M.S., T.K.P., D.E.M.); The Heart Hospital Baylor Plano, TX (G.F.); Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville (G.A.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.T.); and Department of Cardiac Surgery, Washington University School of Medicine and Barnes-Jewish Hospital, St Louis, MO (R.D.). giovanfi@baylorhealth.edu.
Insights
Women experience a lower risk of new-onset atrial fibrillation (AF) after coronary artery bypass graft (CABG) surgery and shorter AF episodes compared to men. Further research is needed for sex-specific AF management post-CABG.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- New-onset atrial fibrillation (AF) following coronary artery bypass graft (CABG) surgery is linked to increased patient morbidity and reduced long-term survival.
- While sex-based outcome differences after CABG are documented, specific data on the incidence and characteristics of post-CABG AF in women versus men remain limited.
Purpose of the Study:
- To investigate the sex-specific incidence and characteristics of new-onset atrial fibrillation (AF) in patients undergoing isolated coronary artery bypass graft (CABG) surgery.
- To compare the risk, duration, and outcomes of post-CABG AF between women and men.
Main Methods:
- A retrospective analysis of 11,236 patients without preoperative AF who underwent isolated CABG between 2002 and 2010.
- Data were sourced from the Society of Thoracic Surgeons database, augmented with continuous ECG/telemetry monitoring for AF detection.
- Statistical adjustments were made for known risk factors using logistic regression models.
Main Results:
- The overall incidence of post-CABG AF was 29.5%, with 30.2% in men and 27.4% in women.
- After risk factor adjustment, women had a significantly lower risk of post-CABG AF (OR 0.75; 95% CI 0.64-0.89).
- Women experienced shorter durations of AF episodes, and AF-free probabilities at 48 hours were higher in women (77%) than men (72%).
Conclusions:
- Women exhibit a lower adjusted risk for new-onset atrial fibrillation after isolated CABG and shorter AF episode durations.
- Operative mortality and stroke incidence did not significantly differ by sex.
- Further investigation into sex-specific impacts is crucial for optimizing AF prevention and management strategies post-CABG.
Background:
New-onset atrial fibrillation (AF) after coronary artery bypass graft surgery (CABG) is associated with increased morbidity and poorer long-term survival. Although many studies show differences in outcome in women versus men after CABG, little is known about the sex-specific incidence and characteristics of post-CABG AF.
Methods And Results:
Overall, 11 236 consecutive patients without preoperative AF underwent isolated CABG from 2002 to 2010 at 4 US academic medical centers and 1 high-volume specialty cardiac hospital. Data routinely collected for the Society of Thoracic Surgeons database were augmented with details on new-onset post-CABG AF events detected via continuous in-hospital ECG/telemetry monitoring. Unadjusted incidence of post-CABG AF was 29.5% (3312/11 236) overall, 30.2% (2485/8214) in men, and 27.4% (827/3022) in women. After adjustment for Society of Thoracic Surgeons-recognized risk factors, women had significantly lower risk for post-CABG AF (odds ratio [95% confidence interval]=0.75 [0.64-0.89]), shorter first, longest, and total duration of AF episodes (mean difference [95% confidence interval]=-2.7 [-4.7 to -0.8] hours; -4.1 [-6.9 to -1.2] hours; -2.4 [-2.5 to -2.3] hours, respectively). At 48 hours, AF-free probabilities were 77% for women and 72% for men (P<0.001). Number of episodes (P=0.18), operative mortality (P=0.048), stroke (P=0.126), and discharge in AF (P=0.234) did not differ significantly by sex.
Conclusions:
These novel data on sex-specific characteristics of new-onset AF after isolated CABG show that women had lower adjusted risk for post-CABG AF and experienced shorter episodes. Investigation of sex-specific impacts on outcomes is needed to identify optimal strategies for prevention and management to ensure all patients achieve the best possible outcomes.
