Atrial Fibrillation After Isolated Coronary Surgery Affects Late Survival

Abstract

Background-Atrial fibrillation (AF) after coronary artery bypass graft surgery is a difficult problem and a continuing source of morbidity and mortality. However, the prognostic implications of postoperative AF are still in dispute. Our aim was to ascertain the impact of AF after coronary artery bypass graft on postoperative survival and to assess its prognostic role in cause-specific mortality. Methods and Results-We conducted a prospective observational study of 1832 patients undergoing isolated coronary artery bypass graft between January 2000 and December 2005 at 2 cardiac surgery centers in northern Italy. Patients affected by postoperative AF were identified and followed up until death or study end (April 30, 2007). A total of 570 patients (31%) developed AF after coronary surgery. Patients affected by postoperative AF experienced a longer hospital stay (7 days [25th to 75th percentile, 7 to 10 days] versus 7 days [25th to 75th percentile, 6 to 8 days]; PϽ0.001). Hospital mortality also was higher in AF patients (3.3% versus 0.5%; PϽ0.001). On discharge, 1806 patients were alive; 143 were lost to follow-up. The remaining 1663 were followed up for a median of 51 months (25th to 75th percentile, 41 to 63 months); 126 of them died after a median of 14 months (25th to 75th percentile, 5 to 32 months). Long-term mortality rates were significantly higher for patients with postoperative AF (2.99 per 100 person-years; 95% confidence interval, 2.33 to 3.84; 61 deaths) compared with those without the arrhythmia (1.34 per 100 person-years; 95% confidence interval, 1.05 to 1.71; 65 deaths), with an adjusted hazard ratio of 2.13 (PϽ0.001) and 2.56 (Pϭ0.001) when also accounting for the prescription of warfarin at discharge. With Cox regression, patients with AF were shown to be at higher risk of dying from embolism (adjusted hazard ratio, 4.33; 95% confidence interval, 1.78 to 10.52) but not from other causes. Conclusions-Postoperative AF affects early and late mortality after isolated coronary artery bypass graft surgery. Patients affected by AF are at higher risk of fatal embolic events. Careful postoperative surveillance with a specific antiarrhythmic and antithrombotic prophylaxis, aimed at reducing AF and its complications, is recommended.

Statins Reduce Short‐ and Long‐Term Mortality Associated With Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting: Impact of Postoperative Atrial Fibrillation and Statin Therapy on Survival

“…Even when using this comprehensive adjustment, POAF remained a significant and independent predictor of longterm mortality. The results of our study, supported by the results of other well-conducted studies in the field of coronary surgery, 1,5,8,11 provide strong evidence for a significant impact of POAF on long-term survival.…”

“…Although POAF appears to be a benign complication in the majority of patients, the present study and other recent studies 1,5,8,12 have pinpointed that POAF is a strong and independent predictor of both operative and late mortality. Patients who develop POAF should be considered at higher risk for adverse outcomes in the short and long term.…”

“…1,3,4,6,8,11 Kalavrouziotis et al found that unadjusted mortality rates were similar in patients with and without POAF (3% vs 2.5% respectively, P = 0.99) in a series of 7347 patients undergoing valvular and/or coronary surgery. 6 In contrast, Villareal et al studied patients with isolated CABG and found a strong and independent association between POAF and operative mortality.…”

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…Długoterminowo u pacjentów z epizodem AF w okresie pooperacyjnym stwierdza się 2-krotny wzrost umieralności z przyczyn sercowo-naczyniowych oraz znacznie zwiększone ryzyko AF i udaru niedokrwiennego w przyszłości w porównaniu z pacjentami, u których po operacji utrzymywał się rytm zatokowy [952][953][954][955][956][957][958]. Doustne leczenie przeciwzakrzepowe w momencie wypisania ze szpitala wią-zało się w odległej obserwacji ze zmniejszeniem umieralności u pacjentów z AF w okresie pooperacyjnym [959], choć nie ma dowodów z kontrolowanych prób klinicznych.…”

Guidelines on myocardial revascularization

“…Arrhythmias in patients with ischaemic heart disease 9.7.1. Atrial fibrillation Atrial fibrillation in patients scheduled for coronary artery bypass grafting The presence of AF in patients scheduled for CABG is independently associated with increased late cardiac morbidity and mortality and poor long-term prognosis [178,179]. Therefore, concomitant ablative treatment of AF during surgery may be considered in those patients although no prospective RCT has addressed this issue.…”