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Prediction of postoperative atrial fibrillation in a large coronary artery bypass grafting cohort
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
2012 (English)In: Interactive Cardiovascular and Thoracic Surgery, ISSN 1569-9293, E-ISSN 1569-9285, Vol. 14, no 5, 588-593 p.Article in journal (Refereed) Published
Abstract [en]

The objective of this study was to identify and evaluate predictors of postoperative atrial fibrillation (POAF) in a large coronary artery bypass grafting (CABG) cohort. This was a single centre study of 7115 consecutive patients with preoperative sinus rhythm who underwent isolated CABG between January 1996 and December 2009. Independent risk factors for POAF were identified with multiple logistic regression. The predictive quality of the final model was evaluated by comparing predicted and observed events of POAF, in an effort to find patients at high risk of developing POAF. After CABG, 2270 patients (32%) developed POAF during hospital stay. Independent risk factors of POAF included advancing age (odds ratio, OR 2.0-7.3), preoperative S-creatinine ≥ 150 µmol/l (OR 1.6), male gender (OR 1.2), New York Heart Association class III/IV (OR, 1.2), smoking (OR 1.1), prior myocardial infarction (OR 1.1) and absence of hyperlipidemia (OR 0.9). The final prediction model was moderate (area under curve, 0.62; 95% confidence interval, 0.61-0.64). Patients with POAF had more postoperative complications, including a higher incidence of stroke and increased length of hospital stay. In conclusion, several risk factors for POAF were identified, but the moderate value of the prediction model confirms the difficulty of identifying patients at high risk of developing POAF after CABG.

Place, publisher, year, edition, pages
2012. Vol. 14, no 5, 588-593 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-181439DOI: 10.1093/icvts/ivr162ISI: 000310174900020PubMedID: 22314010OAI: oai:DiVA.org:uu-181439DiVA: diva2:556125
Available from: 2012-09-24 Created: 2012-09-24 Last updated: 2017-12-07Bibliographically approved
In thesis
1. Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting: Risk factors and clinical outcome
Open this publication in new window or tab >>Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting: Risk factors and clinical outcome
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Postoperative atrial fibrillation (POAF) is a common complication after coronary artery bypass grafting (CABG), and more knowledge is needed regarding prediction of POAF, the extent of early atrial fibrillation (AF) recurrence after discharge, and the associations between POAF and short and long-term overall and cause-specific mortality and morbidity.

After CABG, 31-32% of all patients developed POAF. Several independent risk factors were identified, including increasing age, preoperative S-creatinine ≥150 µmol/l, male gender, NYHA class III/IV, current smoking, prior myocardial infarction (MI), and absence of hyperlipidaemia. The discriminatory ability of the final prediction model was moderate. POAF patients had a higher incidence of early postoperative complications, including stroke and heart failure (HF) and longer hospital stays. In-hospital mortality did not differ between groups.

In long-term follow-up, POAF was independently associated with increased risk of late cardiac mortality after CABG. Examining both underlying and contributing causes of death, POAF was associated with death related to arrhythmia, cerebrovascular disease and HF. The associations remained for more than 8 years.

Observation of heart rhythm during the 30 days following discharge after CABG revealed that 30% of all patients experienced episodes of post-discharge AF. Of all patients with AF, 35% did not experience any symptoms. Patients with POAF had a higher incidence of post-discharge AF, but high incidences were recorded both for patients with POAF (58%) and with sinus rhythm (19%) in-hospital.

POAF was associated with increased long-term risk of overall, cardiac and cerebrovascular mortality, ischemic stroke and HF, and displayed higher incidence rates of these morbidities after CABG. Furthermore, POAF was recognised as a recurrent condition where AF in relation to surgery was a precursor to both first and subsequent events of AF during follow-up. Occurrence of AF, HF, MI and ischemic stroke during follow-up further increased overall mortality.

In conclusion, POAF is common after CABG and remains hard to accurately predict. POAF patients experience more postoperative complications, a higher incidence of post-discharge AF and a recurrent pattern of AF long-term. POAF is also associated with an increased risk of cardiovascular-related mortality, and ischemic stroke and HF in long-term follow-up.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. 62 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1391
Keyword
atrial fibrillation, coronary artery bypass grafting, coronary artery disease, epidemiology, morbidity, mortality, outcome
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-332125 (URN)978-91-513-0133-4 (ISBN)
Public defence
2017-12-18, Robergsalen, Akademiska sjukhuset, Ing 40, 4 tr, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2017-11-24 Created: 2017-10-26 Last updated: 2017-11-24

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Thorén, EmmaHellgren, LailaJidéus, LenaStåhle, Elisabeth

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