Atrial fibrillation in patients undergoing coronary artery surgery is associated with adverse outcome

Gorav Batra,Anders Ahlsson,Bertil Lindahl,Lars Lindhagen,Anders Wickbom,Jonas Oldgren

doi:10.1080/03009734.2018.1504148

Gorav Batra, Anders Ahlsson + Show 4 more

Open Access

https://doi.org/10.1080/03009734.2018.1504148

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Abstract

Background: The aim was to determine the association between atrial fibrillation (AF) and outcome in patients undergoing coronary artery bypass grafting (CABG).Methods: All patients undergoing CABG between January 2010 and June 2013 were identified in the Swedish Heart Surgery Registry. Outcomes studied were all-cause mortality, cardiovascular mortality, myocardial infarction, congestive heart failure, ischemic stroke, and recurrent AF. Patients with history of AF prior to surgery (preoperative AF) and patients without history of AF but with AF episodes post-surgery (postoperative AF) were compared to patients with no AF using adjusted Cox regression models.Results: Among 9,107 identified patients, 8.1% (n = 737) had preoperative AF, and 25.1% (n = 2,290) had postoperative AF. Median follow-up was 2.2 years. Compared to no AF, preoperative AF was associated with higher risk of all-cause mortality, adjusted hazard ratio with 95% confidence interval (HR) 1.76 (1.33–2.33); cardiovascular mortality, HR 2.43 (1.68–3.50); and congestive heart failure, HR 2.21 (1.72–2.84). Postoperative AF was associated with risk of all-cause mortality, HR 1.27 (1.01–1.60); cardiovascular mortality, HR 1.52 (1.10–2.11); congestive heart failure, HR 1.47 (1.18–1.83); and recurrent AF, HR 4.38 (2.46–7.78). No significant association was observed between pre- or postoperative AF and risk for myocardial infarction and ischemic stroke.Conclusions: Approximately 1 in 3 patients undergoing CABG had pre- or postoperative AF. Patients with pre- or postoperative AF were at higher risk of all-cause mortality, cardiovascular mortality, and congestive heart failure, but not of myocardial infarction or ischemic stroke. Postoperative AF was associated with higher risk of recurrent AF.

Highlights

Atrial fibrillation (AF) is a common arrhythmia with an increasing incidence due to aging population [1]
Pre- and postoperative atrial fibrillation (AF) were both significantly associated with higher risk of long-term all-cause mortality, cardiovascular mortality, and hospitalization due to congestive heart failure
No significant association was observed between AF status and risk for ischemic stroke and myocardial infarction

Summary

Introduction

Atrial fibrillation (AF) is a common arrhythmia with an increasing incidence due to aging population [1]. Only two single-center studies have reported outcome in patients with preoperative AF undergoing CABG, both reporting an increased risk of long-term mortality [4,5]. Previous studies have found postoperative AF to be associated with increased risk of short-term mortality and stroke [6,8,9]. Only two single-center studies have assessed the risk of recurrent AF in patients with new-onset postoperative AF, with data suggesting an increased risk [7,12]. In this study on patients undergoing CABG, based on data from Swedish registers with complete national coverage, we sought to answer the following question: In patients undergoing isolated CABG, what are the impacts of preoperative AF and new-onset postoperative AF on all-cause and cardiovascular mortality, myocardial infarction, congestive heart failure, ischemic stroke, and recurrent AF?

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