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Atrial fibrillation in patients undergoing coronary artery surgery is associated with adverse outcome

Gorav Batra1,2, Anders Ahlsson3, Bertil Lindahl1,2

  • 1a Uppsala Clinical Research Center , Uppsala , Sweden.

Upsala Journal of Medical Sciences
|September 29, 2018
PubMed

Insights

Patients undergoing coronary artery bypass grafting (CABG) with atrial fibrillation (AF) face increased mortality and heart failure risks. Postoperative AF also elevates the risk of recurrent AF, highlighting the importance of managing this arrhythmia post-surgery.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Clinical Outcomes Research

Background:

  • Atrial fibrillation (AF) is a common comorbidity in patients undergoing cardiac surgery.
  • The impact of pre-existing and newly developed AF on outcomes after coronary artery bypass grafting (CABG) requires further elucidation.

Purpose of the Study:

  • To investigate the association between preoperative and postoperative atrial fibrillation (AF) and clinical outcomes in patients undergoing coronary artery bypass grafting (CABG).

Main Methods:

  • A cohort of 9,107 patients undergoing CABG between 2010 and 2013 was identified from the Swedish Heart Surgery Registry.
  • Outcomes including all-cause mortality, cardiovascular mortality, myocardial infarction, congestive heart failure, ischemic stroke, and recurrent AF were analyzed.
  • Adjusted Cox regression models were used to compare outcomes between patients with no AF, preoperative AF, and postoperative AF.

Main Results:

  • Preoperative AF (8.1%) was linked to significantly higher risks of all-cause mortality (HR 1.76), cardiovascular mortality (HR 2.43), and congestive heart failure (HR 2.21).
  • Postoperative AF (25.1%) was associated with increased risks of all-cause mortality (HR 1.27), cardiovascular mortality (HR 1.52), congestive heart failure (HR 1.47), and recurrent AF (HR 4.38).
  • Neither preoperative nor postoperative AF showed a significant association with myocardial infarction or ischemic stroke.

Conclusions:

  • Approximately one-third of CABG patients experienced either preoperative or postoperative AF.
  • Both pre- and postoperative AF significantly increase the risk of mortality and congestive heart failure following CABG.
  • Postoperative AF independently predicts a higher likelihood of recurrent AF, emphasizing the need for vigilant monitoring and management.
Abstract

Keywords:
Atrial fibrillationcardiovascular diseasecoronary artery bypass grafting

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