Original article
Adult cardiac
The Impact of New-Onset Postoperative Atrial Fibrillation on Mortality After Coronary Artery Bypass Grafting

https://doi.org/10.1016/j.athoracsur.2010.03.083Get rights and content

Background

New-onset postoperative atrial fibrillation (POAF) is a frequent rhythm disturbance after coronary artery bypass grafting (CABG). This study investigated the independent effect of POAF on early and late mortality after isolated CABG.

Methods

Data of patients who consecutively underwent isolated CABG between January 2003 and December 2007 were prospectively collected. The analysis included 5098 patients with preoperative sinus rhythm and no history of atrial fibrillation. Logistic regression analysis for early mortality and Cox regression analysis for late mortality were performed. Propensity score matching was performed to eliminate the effect of confounders.

Results

Median follow-up was 2.5 years. POAF was documented in 1122 patients (22.0%). Early mortality was more frequent in POAF patients (3.1%) vs non-POAF patients (1.6%, p = 0.002), but multivariate logistic regression analysis could not identify POAF as an independent predictor of early mortality (p = 0.169). This outcome did not change after adjusting for quintiles of the propensity score of POAF (p = 0.100). Multivariate Cox proportional hazard analyses demonstrated POAF was an independent predictor of overall and late mortality with hazard ratios of 1.35 (p = 0.012 and p = 0.039, respectively). Analyses after propensity score matching showed that patients with POAF had similar hazard ratios of 1.36 for overall mortality and 1.34 for late mortality (p = 0.009 and p = 0.042, respectively).

Conclusions

POAF is an independent predictor of overall and late mortality after isolated CABG but not of early mortality.

Section snippets

Material and Methods

The Institutional Research Review Board approved this study and waived the need for patient consent.

Results

Between January 2003 and December 2007, 5352 patients underwent isolated CABG. Mortality data of 5320 patients (99.4%) were collected until March 31, 2008. After excluding patients with a history of AF or without sinus rhythm preoperatively, data of 5098 patients were used for the analysis. Postoperative AF was documented in 1122 patients (22.0%). Median length of hospital stay was 5 days (IQR, 3 to 6 days) in non-POAF patients and 6 days (IQR, 4 to 7 days) in POAF patients. Median follow-up

Comment

This study shows that the incidence of newly developed POAF after CABG in our population is 22%. This incidence is consistent with other studies [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12]. POAF was an independent predictor for late but not for early mortality.

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