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Postoperative atrial fibrillation and mortality after coronary artery bypass surgery.
J Am Coll Cardiol. 2004 Mar 03; 43(5):742-8.JACC

Abstract

OBJECTIVES

We sought to determine if the occurrence of postoperative atrial fibrillation (AF) affects early or late mortality following coronary artery bypass surgery (CABG).

BACKGROUND

Atrial fibrillation is the most common arrhythmia seen following CABG.

METHODS

The Texas Heart Institute Cardiovascular Research Database was used to identify all patients that developed AF after isolated initial CABG from January 1993 to December 1999 (n = 994). This population was compared with patients who underwent CABG during the same period but did not develop AF (n = 5,481). In-hospital end points were adjusted using logistic regression models to account for baseline differences. Long-term survival was evaluated using a retrospective cohort design, where Cox proportional hazards methods were used to adjust for baseline differences, and with case-matched populations (n = 390, 195 per arm).

RESULTS

Atrial fibrillation was diagnosed in 16% of the population. Postoperative AF was associated with greater in-hospital mortality (odds ratio [OR] 1.7, p = 0.0001), more strokes (OR 2.02, p = 0.001), prolonged hospital stays (14 vs. 10 days, p < 0.0001), and a reduced incidence of myocardial infarction (OR 0.62, p = 0.01). At four to five years, survival was worse in patients who developed postoperative AF (74% vs. 87%, p < 0.0001 in the retrospective cohort; 80% vs. 93%, p = 0.003 in the case-matched population). On multivariate analysis, postoperative AF was an independent predictor of long-term mortality (adjusted OR 1.5, p < 0.001 in the retrospective cohort; OR 3.4, p = 0.0018 in the case-matched population).

CONCLUSIONS

The occurrence of AF following CABG identifies a subset of patients who have a reduced survival probability following CABG. The impact of various strategies, such as antiarrhythmics and warfarin, aimed at reducing AF and its complications deserves further study.

Authors+Show Affiliations

Section of Cardiology, Self Regional Healthcare, Greenwood, South Carolina 29646, USA. rollovillareal@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

14998610

Citation

Villareal, Rollo P., et al. "Postoperative Atrial Fibrillation and Mortality After Coronary Artery Bypass Surgery." Journal of the American College of Cardiology, vol. 43, no. 5, 2004, pp. 742-8.
Villareal RP, Hariharan R, Liu BC, et al. Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. J Am Coll Cardiol. 2004;43(5):742-8.
Villareal, R. P., Hariharan, R., Liu, B. C., Kar, B., Lee, V. V., Elayda, M., Lopez, J. A., Rasekh, A., Wilson, J. M., & Massumi, A. (2004). Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. Journal of the American College of Cardiology, 43(5), 742-8.
Villareal RP, et al. Postoperative Atrial Fibrillation and Mortality After Coronary Artery Bypass Surgery. J Am Coll Cardiol. 2004 Mar 3;43(5):742-8. PubMed PMID: 14998610.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. AU - Villareal,Rollo P, AU - Hariharan,Ramesh, AU - Liu,Brant C, AU - Kar,Biswajit, AU - Lee,Vei-Vei, AU - Elayda,MacArthur, AU - Lopez,J Alberto, AU - Rasekh,Abdi, AU - Wilson,James M, AU - Massumi,Ali, PY - 2002/06/25/received PY - 2002/10/25/revised PY - 2003/11/13/accepted PY - 2004/3/5/pubmed PY - 2004/5/1/medline PY - 2004/3/5/entrez SP - 742 EP - 8 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 43 IS - 5 N2 - OBJECTIVES: We sought to determine if the occurrence of postoperative atrial fibrillation (AF) affects early or late mortality following coronary artery bypass surgery (CABG). BACKGROUND: Atrial fibrillation is the most common arrhythmia seen following CABG. METHODS: The Texas Heart Institute Cardiovascular Research Database was used to identify all patients that developed AF after isolated initial CABG from January 1993 to December 1999 (n = 994). This population was compared with patients who underwent CABG during the same period but did not develop AF (n = 5,481). In-hospital end points were adjusted using logistic regression models to account for baseline differences. Long-term survival was evaluated using a retrospective cohort design, where Cox proportional hazards methods were used to adjust for baseline differences, and with case-matched populations (n = 390, 195 per arm). RESULTS: Atrial fibrillation was diagnosed in 16% of the population. Postoperative AF was associated with greater in-hospital mortality (odds ratio [OR] 1.7, p = 0.0001), more strokes (OR 2.02, p = 0.001), prolonged hospital stays (14 vs. 10 days, p < 0.0001), and a reduced incidence of myocardial infarction (OR 0.62, p = 0.01). At four to five years, survival was worse in patients who developed postoperative AF (74% vs. 87%, p < 0.0001 in the retrospective cohort; 80% vs. 93%, p = 0.003 in the case-matched population). On multivariate analysis, postoperative AF was an independent predictor of long-term mortality (adjusted OR 1.5, p < 0.001 in the retrospective cohort; OR 3.4, p = 0.0018 in the case-matched population). CONCLUSIONS: The occurrence of AF following CABG identifies a subset of patients who have a reduced survival probability following CABG. The impact of various strategies, such as antiarrhythmics and warfarin, aimed at reducing AF and its complications deserves further study. SN - 0735-1097 UR - https://www.unboundmedicine.com/medline/citation/14998610/Postoperative_atrial_fibrillation_and_mortality_after_coronary_artery_bypass_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735109703016243 DB - PRIME DP - Unbound Medicine ER -