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Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting
Yuki Kuroda1,2, Hiroki Shiomi3, Takeshi Morimoto4
1Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine.
Insights
Postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) increases long-term risks for major bleeding, stroke, and heart failure, but not mortality. This finding impacts patient management after CABG surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Clinical Outcomes Research
Background:
- Postoperative atrial fibrillation (POAF) following coronary artery bypass grafting (CABG) has a controversial impact on long-term outcomes.
- Understanding these long-term effects is crucial for managing patients undergoing CABG.
Purpose of the Study:
- To investigate the long-term clinical outcomes of patients who develop POAF after CABG compared to those who do not.
- To assess the association between POAF and mortality, stroke, heart failure, and major bleeding events.
Main Methods:
- Retrospective analysis of 1,483 patients undergoing CABG without prior atrial fibrillation (AF) from the CREDO-Kyoto Registry Cohort-3.
- POAF was defined as new-onset AF during the index hospitalization.
- Follow-up extended to a median of 5.7 years post-discharge.
Main Results:
- POAF was diagnosed in 23% of the study cohort.
- The 5-year incidence of all-cause death did not differ significantly between POAF and non-POAF groups.
- Patients with POAF had significantly higher rates of major bleeding (BARC type 3 or 5) and numerically higher rates of stroke and heart failure.
Conclusions:
- POAF after CABG is associated with a significantly increased long-term risk of major bleeding.
- The long-term risk for stroke and heart failure is numerically higher in patients with POAF.
- No significant difference in long-term all-cause mortality was observed between patients with and without POAF.
Background:
The impact of postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) on long-term clinical outcomes remains controversial.
Methods And Results:
Of 14,927 consecutive patients with their first coronary revascularization in the CREDO-Kyoto Registry Cohort-3, we extracted data for 1,483 undergoing CABG without prior atrial fibrillation (AF). POAF was defined as newly documented AF during hospitalization for CABG and was diagnosed in 337 (23%) patients during the index hospitalization. The remaining 1,146 patients were categorized as the non-POAF group. The median follow-up after discharge was 5.7 years. The cumulative 5-year incidence of all-cause death did not differ significantly between the POAF and non-POAF groups (15.9% vs. 13.0%, respectively; P=0.38), whereas the cumulative 5-year incidence of stroke, heart failure, and Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding was significantly higher in the POAF group. There was no excess adjusted risk of the POAF group relative to the non-POAF group for all-cause death (hazard ratio 0.96; 95% confidence interval 0.70-1.31; P=0.81). The risk of the POAF group relative to the non-POAF group was numerically higher for stroke and heart failure, and significantly higher for BARC type 3 or 5 bleeding.
Conclusions:
The long-term risk of patients with POAF relative to those without was significantly higher for major bleeding and numerically higher for stroke and heart failure, with no difference for mortality.
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