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Outcomes in Early Postoperative Versus Late New-Onset Atrial Fibrillation After Coronary Artery Bypass Grafting
Florian E M Herrmann1,2,3, Amar Taha1,4, Mary Rezk1,5
1Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy University of Gothenburg Sweden.
Insights
New-onset postoperative atrial fibrillation (POAF) early after coronary artery bypass grafting (CABG) carries a lower risk of adverse outcomes compared to late-onset AF. These findings suggest POAF and late AF are distinct clinical entities requiring different management strategies.
Area of Science:
- Cardiology
- Cardiac Surgery
- Clinical Research
Background:
- Postoperative atrial fibrillation (POAF) is a common complication after coronary artery bypass grafting (CABG).
- The comparative risk of adverse outcomes between early (POAF) and late-onset atrial fibrillation (AF) following CABG remains unclear.
- Understanding these differences is crucial for optimizing patient management and treatment strategies.
Purpose of the Study:
- To compare the risk of adverse outcomes between new-onset postoperative atrial fibrillation (POAF) occurring early after CABG and new-onset atrial fibrillation occurring later.
- To determine if POAF and late AF post-CABG represent distinct clinical entities with different prognoses.
Main Methods:
- A nationwide cohort study in Sweden (2007-2020) included patients undergoing CABG.
- Individual patient data from multiple national registries were merged, including SWEDEHEART.
- Adjusted incidences of mortality, stroke, thromboembolism, heart failure hospitalization, and major bleeding were compared between POAF and late AF using multivariable Poisson regression.
Main Results:
- Out of 35,329 patients, 30.0% developed POAF and 2.5% developed late AF.
- Crude mortality rates were significantly lower in patients with POAF compared to those with late AF.
- Late AF was associated with significantly higher adjusted risks for all-cause mortality, ischemic stroke, thromboembolism, heart failure hospitalization, and major bleeding compared to POAF.
Conclusions:
- POAF after CABG is associated with a substantially lower risk of morbidity and mortality than late new-onset AF.
- POAF and late new-onset AF post-CABG are distinct clinical entities.
- Different treatment strategies may be warranted for POAF versus late AF after CABG.
Background:
It is unclear whether new-onset postoperative atrial fibrillation (POAF) early after coronary artery bypass grafting (CABG) is associated with a similar risk of adverse outcomes as new-onset atrial fibrillation occurring later after CABG.
Methods:
All patients treated with CABG in Sweden from 2007 to 2020 were investigated. Individual patient data from SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry and 3 other prospective national registries were merged. The adjusted incidences of all-cause mortality, ischemic stroke, any thromboembolism, heart failure hospitalization, and major bleeding within 12 months after debut of POAF (AF occurring before hospital discharge) or Late AF (new-onset AF occurring between 3 months and 3 years after CABG) were compared by multivariable Poisson regression analysis, adjusted for time-updated patient characteristics and comorbidities.
Results:
Out of 35 329 patients, 10 609 (30.0%) developed POAF and 628 (2.5%) developed Late AF. The crude mortality rate was lower in patients with POAF than in patients with Late AF (1.88 [95% CI, 1.63-2.17] versus 9.08 [95% CI, 6.92-11.82] per 100 patient-years). The adjusted incidence rate ratios for all-cause mortality (2.91 [95% CI, 2.10-3.95]); ischemic stroke (1.70 [95% CI, 1.15-2.44]); any thromboembolism (1.59 [95% CI, 1.11-2.22]), heart failure hospitalization (1.61 [95% CI, 1.19-2.12]); and major bleeding (1.73 [95% CI, 1.24-2.36]) were higher in patients with Late AF.
Conclusions:
POAF was associated with a markedly lower risk for morbidity and mortality than late new-onset AF after CABG. POAF and late new-onset AF after CABG are 2 different clinical entities of AF that may require different treatment strategies.
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