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Patients who develop post-operative atrial fibrillation have reduced survival after off-pump coronary artery bypass
Akhil Ghurram1, Neethu Krishna1, Renjitha Bhaskaran2
11Department of Cardiothoracic Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India.
Insights
Post-operative atrial fibrillation (POAF) after off-pump CABG is less common in Indian patients. Age and sepsis independently predict POAF, which is linked to higher mortality and longer hospital stays.
Area of Science:
- Cardiology
- Cardiac Surgery
- Clinical Outcomes
Background:
- Post-operative atrial fibrillation (POAF) is a common complication following cardiac surgery, associated with increased morbidity, mortality, and healthcare costs.
- Data on POAF incidence and impact in Indian patients undergoing off-pump coronary artery bypass grafting (CABG) is limited.
Purpose of the Study:
- To investigate the incidence, predictors, and outcomes of POAF in Indian patients undergoing off-pump CABG.
- To compare the long-term survival rates between patients who develop POAF and those who remain in normal sinus rhythm (NSR).
Main Methods:
- A retrospective analysis of 748 patients who underwent off-pump CABG between January 2015 and December 2016.
- POAF development was recorded, and independent predictors were identified using multivariable analysis. A sub-analysis based on EuroSCORE II risk stratification was also performed.
Main Results:
- The incidence of POAF was 16.7% (127 patients). Independent predictors for POAF included age >60 years and sepsis.
- POAF was associated with significantly higher 30-day mortality (7.1% vs. 1.4%), increased ICU and hospital stay, and higher incidence of stroke and renal dysfunction.
- Three-year survival was significantly lower in the POAF group (81.3%) compared to the NSR group (94.4%) (HR 3.867).
Conclusions:
- The incidence of POAF in this Indian cohort was lower than reported globally.
- Increasing age and post-operative sepsis are significant predictors of POAF after off-pump CABG.
- POAF adversely affects patient outcomes, increasing morbidity, hospital stay, and decreasing long-term survival.
Objective:
Post-operative atrial fibrillation (POAF) increases hospital stay, resource utilization, morbidity, and mortality. However, there is paucity of data about its effect in Indian patients undergoing off-pump coronary artery bypass grafting (CABG).
Methods:
Seven hundred forty-eight patients underwent off-pump CABG from January 2015 to December 2016 (24 months). One hundred twenty-seven patients (16.7%) developed POAF. In an effort to mitigate the effects of wider risk factors on perioperative outcomes, a separate sub-analysis of patients based on risks quantified by EuroSCORE II (<> 3) was also performed.
Results:
Age > 60 years and development of sepsis were the independent predictors for the development of POAF. Thirty-day/mortality rate was higher in the POAF group (7.1% vs. 1.4%; p value < 0.001). POAF was associated with increased ICU and hospital stay and increased incidence of stroke and renal dysfunction. The survival was significantly lower in the POAF group compared with the normal sinus rhythm (NSR) (3-year survival in POAF was 81.3% vs. 94.4% in the NSR group; Hazard ratio (HR) 3.867 (1.989-7.516)). Intra-aortic balloon pump (IABP) usage, age ≥ 60 years and sepsis were independent predictors for the development of POAF in low-risk patients. For the NSR group, 1-year survival was 98% and 3-year survival was 95.7%. For the POAF group, 1-year survival was 94.4% and 3-year survival was 84.0% (HR. 3.794 (1.897-7.591)).
Conclusion:
The incidence of POAF was lower than reported in the wider global literature. Increasing age and development of post-operative sepsis were strong independent predictors of POAF. POAF increases the morbidity; length of hospital stay and these patients show decreased survival after off-pump CABG.
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