The online version of this article (https://doi.org/10.1007/s00392-020-01614-z) contains supplementary material, which is available to authorized users.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
To analyze (1) associations between postoperative atrial fibrillation (POAF) after CABG and long-term cardiovascular outcome, (2) whether associations were influenced by AF during follow-up, and (3) if morbidities associated with POAF contribute to mortality.
An observational cohort study of 7145 in-hospital survivors after isolated CABG (1996–2012), with preoperative sinus rhythm and without AF history. Incidence of AF was compared with matched controls. Time-updated covariates were used to adjust for POAF-related morbidities during follow-up, including AF.
Thirty-one percent of patients developed POAF. Median follow-up was 9.8 years. POAF patients had increased AF compared with matched controls (HR 3.03; 95% CI 2.66–3.49), while AF occurrence in non-POAF patients was similar to controls (1.00; 0.89–1.13). The observed AF increase among POAF patients compared with controls persisted over time (> 10 years 2.73; 2.13–3.51). Conversely, the non-POAF cohort showed no AF increase beyond the first postoperative year. Further, POAF was associated with long-term AF (adjusted HR 3.20; 95% CI 2.73–3.76), ischemic stroke (1.23; 1.06–1.42), heart failure (1.44; 1.27–1.63), overall mortality (1.21; 1.11–1.32), cardiac mortality (1.35; 1.18–1.54), and cerebrovascular mortality (1.54; 1.17–2.02). These associations remained after adjustment for AF during follow-up. Adjustment for other POAF-associated morbidities weakened the association between POAF and overall mortality, which became non-significant.
Patients with POAF after CABG had three times the incidence of long-term AF compared with both non-POAF patients and matched controls. POAF was associated with long-term ischemic stroke, heart failure, and corresponding mortality even after adjustment for AF during follow-up. The increased overall mortality was partly explained by morbidities associated with POAF.
Ahlsson A, Fengsrud E, Bodin L, Englund A (2010) Postoperative atrial fibrillation in patients undergoing aortocoronary bypass surgery carries an eightfold risk of future atrial fibrillation and a doubled cardiovascular mortality. Eur J Cardio Thorac Surg 37:1353–1359. https://doi.org/10.1016/j.ejcts.2009.12.033 CrossRef
Lee S-H, Kang DR, Uhm J-S, Shim J, Sung J-H, Kim J-Y, Pak HN, Lee MH, Joung B (2014) New-onset atrial fibrillation predicts long-term newly developed atrial fibrillation after coronary artery bypass graft. Am Heart J 167:593–600.e1. https://doi.org/10.1016/j.ahj.2013.12.010 CrossRefPubMed
Batra G, Ahlsson A, Lindahl B, Lindhagen L, Wickbom A, Oldgren J (2019) Atrial fibrillation in patients undergoing coronary artery surgery is associated with adverse outcome. Ups J Med Sci 124:70–77. https://doi.org/10.1080/03009734.2018.1504148 CrossRefPubMed
Thorén E, Hellgren L, Granath F, Hörte L-G, Ståhle E (2014) Postoperative atrial fibrillation predicts cause-specific late mortality after coronary surgery. Scand Cardiovasc J 48:71–78. https://doi.org/10.3109/14017431.2014.880793 CrossRefPubMed
Tanawuttiwat T, O’Neill BP, Cohen MG, Chinthakanan O, Heldman AW, Martinez CA, Alfonso CE, Mitrani RD, Macon CJ, Carrillo RG, Williams DB, O'Neill WW, Myerburg RJ (2014) New-onset atrial fibrillation after aortic valve replacement: comparison of transfemoral, transapical, transaortic, and surgical approaches. J Am Coll Cardiol 63:1510–1519. https://doi.org/10.1016/j.jacc.2013.11.046 CrossRefPubMed
Kraft F, Schmidt C, Van Aken H, Zarbock A (2015) Inflammatory response and extracorporeal circulation. Best Pract Res Clin Anaesthesiol 29:113–123. https://doi.org/10.1016/j.bpa.2015.03.001 CrossRefPubMed
Echahidi N, Pibarot P, O’Hara G, Mathieu P (2008) Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery. J Am Coll Cardiol 51:793–801. https://doi.org/10.1016/j.jacc.2007.10.043 CrossRefPubMed
D'Agostino RS, Jacobs JP, Badhwar V, Fernandez FG, Paone G, Wormuth DW, Shahian DM (2019) The Society of thoracic surgeons adult cardiac surgery database: 2019 update on outcomes and quality. Ann Thorac Surg 107:24–32. https://doi.org/10.1016/j.athoracsur.2018.10.004 CrossRefPubMed
Kerr CR, Humphries KH, Talajic M, Klein GJ, Connolly SJ, Green M, Boone J, Sheldon R, Dorian P, Newman D (2005) Progression to chronic atrial fibrillation after the initial diagnosis of paroxysmal atrial fibrillation: results from the Canadian Registry of Atrial Fibrillation. Am Heart J 149:489–496. https://doi.org/10.1016/j.ahj.2004.09.053 CrossRefPubMed
Carlisle MA, Fudim M, DeVore AD, Piccini JP (2019) Heart failure and atrial fibrillation, like fire and fury. JACC Heart Fail 7:447–456. https://doi.org/10.1016/j.jchf.2019.03.005 CrossRefPubMed
Kälsch AI, Scharnagl H, Kleber ME, Windpassinger C, Sattler W, Leipe J, Krämer BK, März W, Malle E (2019) Long- and short-term association of low-grade systemic inflammation with cardiovascular mortality in the LURIC study. Clin Res Cardiol. https://doi.org/10.1007/s00392-019-01516-9 CrossRefPubMed
Chen J-W, Lin C-H, Hsu R-B (2015) Mechanisms of early and delayed stroke after systematic off-pump coronary artery bypass. J Formos Med Assoc 114:988–994. https://doi.org/10.1016/j.jfma.2014.01.010 CrossRefPubMed
Likosky DS, Marrin CAS, Caplan LR, Baribeau YR, Morton JR, Weintraub RM, Hartman GS, Hernandez F Jr, Braff SP, Charlesworth DC, Malenka DJ, Ross CS, Connor GT, Northern New England Cardiovascular Disease Study Group (2003) Determination of etiologic mechanisms of strokes secondary to coronary artery bypass graft surgery. Stroke 34:2830–2834. https://doi.org/10.1161/01.STR.0000098650.12386.B3 CrossRefPubMed
Almassi GH, Schowalter T, Nicolosi AC, Aggarwal A, Moritz TE, Henderson WG, Tarazi R, Shroyer AL, Sethi GK, Grover FL, Hammermeister KE (1997) Atrial fibrillation after cardiac surgery: a major morbid event? Ann Surg 226:501–511. https://doi.org/10.1097/00000658-199710000-00011 CrossRefPubMedPubMedCentral
Bhave PD, Goldman LE, Vittinghoff E, Maselli J, Auerbach A (2012) Incidence, predictors, and outcomes associated with postoperative atrial fibrillation after major noncardiac surgery. Am Heart J 164:918–924. https://doi.org/10.1016/j.ahj.2012.09.004 CrossRefPubMedPubMedCentral
Mihos CG, Santana O, Lamas GA, Lamelas J (2013) Incidence of postoperative atrial fibrillation in patients undergoing minimally invasive versus median sternotomy valve surgery. J Thorac Cardiovasc Surg 146:1436–1441. https://doi.org/10.1016/j.jtcvs.2012.09.009 CrossRefPubMed
Kosmidou I, Chen S, Kappetein AP, Serruys PW, Gersh BJ, Puskas JD, Kandzari DE, Taggart DP, Morice MC, Buszman PE, Bochenek A, Schampaert E, Pagé P, Sabik JF 3rd, McAndrew T, Redfors B, Ben-Yehuda O, Stone GW (2018) New-onset atrial fibrillation after PCI or CABG for left main disease: The EXCEL trial. J Am Coll Cardiol 71:739–748. https://doi.org/10.1016/j.jacc.2017.12.012 CrossRefPubMed
Stone GW, Sabik JF, Serruys PW, Simonton CA, Généreux P, Puskas J, Kandzari DE, Morice MC, Lembo N, Brown WM 3rd, Taggart DP, Banning A, Merkely B, Horkay F, Boonstra PW, van Boven AJ, Ungi I, Bogáts G, Mansour S, Noiseux N, Sabaté M, Pomar J, Hickey M, Gershlick A, Buszman P, Bochenek A, Schampaert E, Pagé P, Dressler O, Kosmidou I, Mehran R, Pocock SJ, Kappetein AP, EXCEL Trial Investigators (2016) Everolimus-eluting stents or bypass surgery for left main coronary artery disease. N Engl J Med 375:2223–2235. https://doi.org/10.1056/NEJMoa1610227 CrossRefPubMed
Allessie M, Ausma J, Schotten U (2002) Electrical, contractile and structural remodeling during atrial fibrillation. Cardiovasc Res 54:230–246. https://doi.org/10.1016/s0008-6363(02)00258-4 CrossRefPubMed
Schoonderwoerd BA, Van Gelder IC, Van Veldhuisen DJ, Van den Berg MP, Crijns HJGM (2005) Electrical and structural remodeling: role in the genesis and maintenance of atrial fibrillation. Prog Cardiovasc Dis 48:153–168. https://doi.org/10.1016/j.pcad.2005.06.014 CrossRefPubMed
Butt JH, Xian Y, Peterson ED, Olsen PS, Rørth R, Gundlund A, Olesen JB, Gislason GH, Torp-Pedersen C, Køber L, Fosbøl EL (2018) Long-term thromboembolic risk in patients with postoperative atrial fibrillation after coronary artery bypass graft surgery and patients with nonvalvular atrial fibrillation. JAMA Cardiol 3:417–424. https://doi.org/10.1001/jamacardio.2018.0405 CrossRefPubMedPubMedCentral
Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A, The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC), and the European Association for Cardio-Thoracic Surgery (EACTS) (2014) 2014 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 35:2541–2619. https://doi.org/10.1093/eurheartj/ehu278 CrossRef
Fisher LD, Lin DY (1999) Time-dependent covariates in the Cox proportional-hazards regression model. Annu Rev Public Health 20:145–157. https://doi.org/10.1146/annurev.publhealth.20.1.145 CrossRefPubMed
Lange T, Hansen JV (2011) Direct and indirect effects in a survival context. Epidemiology 22:575–581. https://doi.org/10.1097/EDE.0b013e31821c680c CrossRefPubMed
Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P, ESC Scientific Document Group (2016) 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 37:2893–2962. https://doi.org/10.1093/eurheartj/ehw210 CrossRefPubMed
Eikelboom JW, Connolly SJ, Bosch J, Dagenais GR, Hart RG, Shestakovska O, Diaz R, Alings M, Lonn EM, Anand SS, Widimsky P, Hori M, Avezum A, Piegas LS, Branch KRH, Probstfield J, Bhatt DL, Zhu J, Liang Y, Maggioni AP, Lopez-Jaramillo P, O'Donnell M, Kakkar AK, Fox KAA, Parkhomenko AN, Ertl G, Störk S, Keltai M, Ryden L, Pogosova N, Dans AL, Lanas F, Commerford PJ, Torp-Pedersen C, Guzik TJ, Verhamme PB, Vinereanu D, Kim JH, Tonkin AM, Lewis BS, Felix C, Yusoff K, Steg PG, Metsarinne KP, Cook Bruns N, Misselwitz F, Chen E, Leong D, Yusuf S, COMPASS Investigators (2017) Rivaroxaban with or without aspirin in stable cardiovascular disease. N Engl J Med 377:1319–1330. https://doi.org/10.1056/NEJMoa1709118 CrossRefPubMed
Friberg L, Hammar N, Ringh M, Pettersson H, Rosenqvist M (2006) Stroke prophylaxis in atrial fibrillation: who gets it and who does not? Report from the Stockholm cohort-study on atrial fibrillation (SCAF-study). Eur Heart J 27:1954–1964. https://doi.org/10.1093/eurheartj/ehl146 CrossRefPubMed
- Compared with matched controls, patients with postoperative atrial fibrillation (POAF) have increased long-term AF after CABG, and POAF is further associated with increased ischemic stroke, heart failure and mortality even after adjustment for AF
- Springer Berlin Heidelberg
Clinical Research in Cardiology
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692
Neu im Fachgebiet Kardiologie
Mail Icon II