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Published on: February 26, 2013
Factors Affecting Late Atrial Fibrillation and Its Association With Coronary Artery Bypass Outcomes
Mana Jameie1, Malihe Rezaee1, Mina Pashang1
1Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Late/recurrent atrial fibrillation (AF) after coronary artery bypass grafting (CABG) is linked to advanced age, lower ejection fraction, and prior POAF. However, it did not worsen midterm outcomes in this study.
Area of Science:
- Cardiology
- Cardiac Surgery
- Epidemiology
Background:
- Postoperative atrial fibrillation (POAF) is well-studied, but late/recurrent atrial fibrillation (AF) post-discharge requires more evidence.
- This study investigates predictors and outcomes of late/recurrent AF following coronary artery bypass grafting (CABG).
Purpose of the Study:
- To identify factors associated with late/recurrent AF after CABG.
- To evaluate the impact of late/recurrent AF on midterm outcomes after CABG in a real-world setting.
Main Methods:
- A cohort of 5175 patients undergoing CABG from 2012-2016 was analyzed.
- Competing risk analysis identified independent predictors of late/recurrent AF.
- Cox regression assessed the association between late/recurrent AF and mortality, major adverse cardio-cerebrovascular events, and heart failure admissions.
Main Results:
- Late/recurrent AF developed in 1.64% of patients over a median 60-month follow-up.
- Predictors included advanced age, lower left-ventricular ejection fraction, longer hospital stay, and prior POAF.
- Late/recurrent AF was not significantly associated with all-cause mortality or major adverse cardio-cerebrovascular events after adjustment.
Conclusions:
- Advanced age, lower ejection fraction, and POAF increase the likelihood of late/recurrent AF post-CABG.
- Contrary to intuition, late/recurrent AF did not independently predict worse midterm post-CABG outcomes.
- Further research in diverse settings is needed to understand and manage late AF surveillance.
Background:
Although predictors and outcomes of postoperative atrial fibrillation (POAF) are well studied, evidence is lacking concerning postdischarge late/recurrent atrial fibrillation (AF). This study evaluated factors affecting late/recurrent AF and its association with coronary artery bypass grafting (CABG) outcomes in a real-world setting.
Methods:
From 2012 through 2016, 5175 patients were included. Independent factors associated with late/recurrent AF were identified in a competing risk setting. Cox proportional hazard regression was used to evaluate the association between late/recurrent AF and study outcomes, consisting of all-cause mortality, major adverse cardio-cerebrovascular events, acute coronary syndrome, cerebrovascular events, and heart failure admissions.
Results:
During a median follow-up of 60 months (quartile 1-quartile 3, 59.3-60.7 months), late/recurrent AF developed in 85 patients (1.64%). Independent factors associated with late/recurrent AF were age (subdistribution hazard ratio [sHR], 1.04; 95% CI, 1.02-1.07), left-ventricular ejection fraction (sHR, 0.97; 95% CI, 0.95-0.99), length of stay (sHR, 1.02; 95% CI, 1.01-1.04), and POAF (sHR, 4.02; 95% CI, 2.50-6.45). Late/recurrent AF was not significantly associated with all-cause mortality and major adverse cardio-cerebrovascular events at unadjusted or adjusted levels (adjusted hazard ratio, 0.80 [95% CI, 0.50-1.28] and 0.74 [95% CI, 0.48-1.13], respectively). Nevertheless, it significantly increased the unadjusted risk of cerebrovascular events (hazard ratio, 2.28; 95% CI, 01.07-4.87), which disappeared after adjustments.
Conclusions:
Patients with advanced age, a lower left-ventricular ejection fraction, and POAF are more likely to have late/recurrent clinical AF. Albeit counterintuitive, late/recurrent AF was not independently associated with worse midterm post-CABG outcomes. These observations need to be further elucidated in larger-scale studies and interpreted in the context of a developing country with limited resources for late AF surveillance.
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