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Postoperative atrial fibrillation predicts cause-specific late mortality after coronary 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.
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2014 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 48, no 2, 71-78 p.Article in journal (Refereed) Published
Abstract [en]

Objectives. To investigate the association between postoperative atrial fibrillation (POAF) and cause-specific death after coronary artery bypass grafting (CABG) over time. Design. The cohort included 6821 patients undergoing primary isolated CABG between 1996 and 2009. Survival analyses using Cox proportional hazards determined the association between POAF and late mortality and cause of death. Four categories of mortality were examined: cardiac mortality; and death related to arrhythmia, cerebrovascular disease, and heart failure. Results. Median follow-up was 9.8 years and 2152 of 6821 patients (32%) developed POAF. During follow-up, 2302 of 6821 patients (34%) died. For all mortality categories, lower survival rates were found among POAF patients. After adjustment for baseline characteristics, medical history, and preoperative status, POAF was related to increased mortality in all four categories: cardiac mortality (HR 1.4; 95% CI 1.3-1.5); death related to arrhythmia (HR 1.8; 95% CI 1.6-2.0); cerebrovascular disease (HR 1.4; 95% CI 1.2-1.6); and heart failure (HR 1.4; 95% CI 1.3-1.6). The effect remained more than 8 years after surgery. Conclusions. POAF predicts cause-specific late mortality after CABG, with a sustained effect many years postoperatively. This suggests that POAF-episodes are not merely an indication of more advanced disease at surgery, but predicts a persistent negative effect on cause-specific survival.

Place, publisher, year, edition, pages
2014. Vol. 48, no 2, 71-78 p.
Keyword [en]
atrial fibrillation, coronary artery bypass grafts, CABG, outcomes
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-225544DOI: 10.3109/14017431.2014.880793ISI: 000335134400003OAI: oai:DiVA.org:uu-225544DiVA: diva2:726534
Available from: 2014-06-18 Created: 2014-06-04 Last updated: 2017-12-05Bibliographically 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, LailaStåhle, Elisabeth

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