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Objectives The long-term prognostic role of postoperative atrial fibrillation (POAF) on cardiovascular outcomes in patients undergoing cardiac surgery is uncertain. We aimed to investigate the impact of new-onset POAF on mid-term adverse cardiovascular events after coronary artery bypass graft (CABG) surgery. Methods This was a retrospective cohort study of patients who underwent isolated CABG without a preoperative history of atrial fibrillation/flutter. POAF was defined as episodes of AF lasting ≥30 seconds during the hospitalization period. The effect of POAF on mid-term all-cause mortality and cerebrovascular accidents/transient ischaemic attacks (CVA/TIA) was assessed using a Cox proportional hazard regression model in a competing risk setting. Additional analyses were performed on patients surviving an event-free early postoperative period (i.e. within 30 postoperative days after the index surgery). Results A total of 9,310 patients were followed for a median duration of 48.7 months. New-onset POAF was associated with an increased risk of mid-term all-cause mortality (HR = 1.648, 95% CI: 1.402–1.937; p < 0.001) and CVA/TIA (Subdistribution-HR = 1.635, 1.233–2.167; p = 0.001). After excluding patients who died during the early postoperative period, POAF remained significantly associated with higher late all-cause mortality (HR = 1.518, 1.273–1.811; p < 0.001). However, the risk of late CVA/TIA in patients who survived the early postoperative period without having a stroke was similar between those with and without POAF (Subdistribution-HR = 1.174, 0.797–1.729; p = 0.418). Conclusions New-onset POAF after CABG is associated with an increased risk of mid-term overall mortality and stroke. However, late stroke risk is likely similar between patients with and without POAF who survive an event-free early postoperative period.

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This a preprint and has not been peer reviewed. Data may be preliminary.

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