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Published on: February 26, 2013
Association of Atrial Fibrillation Status With Risk of Strokes, Mortality, and Cardiovascular Outcomes in Patients
Aimy Yan1, Jayant Ravindran2, Vincent Chow2
1Department of Cardiology, Concord Repatriation General Hospital, Sydney Local Health District, Concord, New South Wales, Australia.
Insights
Patients with atrial fibrillation (AF) undergoing coronary-artery-bypass-grafting (CABG) face higher risks of stroke, heart failure, and death. Pre-existing AF poses a greater risk than new-onset post-operative AF (POAF).
Area of Science:
- Cardiology
- Cardiac Surgery
- Epidemiology
Background:
- Post-operative atrial fibrillation (POAF) is a frequent complication after coronary-artery-bypass-grafting (CABG).
- Comparative outcome data for patients with POAF, pre-existing (background) AF, and no AF undergoing CABG are limited.
- Understanding the distinct risks associated with different AF statuses is crucial for patient management.
Purpose of the Study:
- To compare the incidence of major adverse cardiovascular events and mortality among patients undergoing CABG with no AF, background AF, and new-onset POAF.
- To identify the specific risks of stroke, heart failure, and death associated with each AF category post-CABG.
- To inform clinical focus and management strategies for AF patients undergoing CABG.
Main Methods:
- Retrospective analysis of a statewide patient database (2004-2017) for patients undergoing CABG.
- Exclusion of patients under 18 or with concomitant cardiac valve surgery.
- Stratification into no-AF, background-AF, and POAF groups using a look-back linkage methodology; primary outcome: hospitalisation for ischaemic stroke/TIA; secondary outcomes: all-cause mortality, AF/HF hospitalisation, haemorrhagic stroke.
Main Results:
- Among 46,032 patients, 64.7% had no AF, 8.0% had background AF, and 27.4% developed POAF.
- POAF was associated with a significantly increased risk of hospitalisation for ischaemic stroke/TIA compared to no AF (adj.sHR=1.14).
- Patients with background AF showed a substantially higher risk (adj.sHR=1.41) compared to no AF, with a graded increase in morbidities and mortality observed across AF groups.
Conclusions:
- AF status during CABG surgery is linked to a graded increase in hospitalisation risk for ischaemic stroke/TIA, AF, heart failure, and death.
- Patients with pre-existing AF undergoing CABG represent an under-recognized high-risk population.
- Renewed clinical attention is warranted for patients with pre-existing AF undergoing CABG to mitigate adverse outcomes.
Background:
Postoperative atrial fibrillation (POAF) is a common complication following coronary artery bypass grafting (CABG). Comparative outcome studies among patients following CABG with POAF pre-existing/background atrial fibrillation (AF), and no AF are scarce.
Methods:
Patients undergoing CABG between January 1, 2004 and December 31, 2017 were identified from a statewide Admitted Patient Data Collection database. Patients < 18 years of age or with concomitant cardiac valve surgery were excluded. Patients were stratified into no AF, background AF, and POAF during index CABG using a lookback linkage methodology. Primary outcome was incidence of ischemic stroke/transient ischemic attack (TIA) requiring hospitalization. Secondary outcomes included all-cause mortality and hospitalization with AF, heart failure (HF), hemorrhagic stroke. Competing risk and Cox regression methods were used to assess risk for cardiovascular endpoints and death, respectively.
Results:
Among 46,032 patients, 8.0% had background AF, 27.4% developed new-onset POAF during index CABG, and 64.7% had no AF. During follow-up (median 6.6 years), POAF was associated with increased risk of hospitalization for ischemic stroke/TIA compared with no AF cohort (adjusted subdistribution hazard ratio [adj.sHR], 1.14, 95% confidence interval [CI], 1.04-1.24; P = 0.004). The risk appears greater in patients with background AF (adj.sHR, 1.41, 95% CI, 1.25-1.60; P < 0.001). A graded association was observed across AF groups with highest morbidities (AF and HF hospitalizations) and mortality risks post-CABG in patients with background AF, followed by those with POAF, with no AF cohort having lowest event rates.
Conclusions:
This large retrospective observational study suggests AF status during CABG surgery is associated with a graded increased risk of hospitalization for ischemic stroke/TIA, AF, HF, and death. These findings highlight an underrecognized high-risk population and underscore need for renewed clinical focus on patients with pre-existing AF undergoing CABG.
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