Postoperative Atrial Fibrillation and Long-Term Risk of Stroke After Isolated Coronary Artery Bypass Graft Surgery
Послеоперационная фибрилляция предсердий и долгосрочный риск инсульта после изолированного аортокоронарного шунтирования
2020-10-05
SCID: 54.1/b3gws4mx
Discuss with AI
Cox regression analysiscerebrovascular accidentcoronary artery bypass graftinglong-term stroke riskpostoperative atrial fibrillation
Figures from the paper
Abstract (AI)
Background: Postoperative atrial fibrillation (pAF) after coronary artery bypass grafting is a common complication. Whether pAF is associated with an increased risk of cerebrovascular accident (CVA) remains uncertain. We investigated the association between pAF and long-term risk of CVA by performing a post hoc analysis of 10-year outcomes of the ART (Arterial Revascularization Trial). Methods: For the present analysis, among patients enrolled in the ART (n=3102), we excluded those who did not undergo surgery (n=25), had a history of atrial fibrillation (n=45), or had no information on the incidence of pAF (n=9). The final population consisted of 3023 patients, of whom 734 (24.3%) developed pAF with the remaining 2289 maintaining sinus rhythm. Competing risk and Cox regression analyses were used to investigate the association between pAF and the risk of CVA. Results: At 10 years, the cumulative incidence of CVA was 6.3% (4.6%–8.1%) versus 3.7% (2.9%–4.5%) in patients with pAF and sinus rhythm, respectively. pAF was an independent predictor of CVA at 10 years (hazard ratio, 1.53 [95% CI, 1.06–2.23]; P =0.025) even when CVAs that occurred during the index admission were excluded from the analysis (hazard ratio, 1.47 [95% 1.02–2.11]; P =0.04). Conclusions: Patients with pAF after coronary artery bypass grafting are at higher risk of CVA. These findings challenge the notion that pAF is a benign complication.
Key Findings
1
At 10 years, cumulative cerebrovascular accident incidence was 6.3% after postoperative atrial fibrillation versus 3.7% with maintained sinus rhythm.
2
In the ART cohort, postoperative atrial fibrillation occurred in 24.3% of 3,023 patients undergoing isolated coronary artery bypass grafting.
3
Postoperative atrial fibrillation independently predicted 10-year cerebrovascular accident risk (hazard ratio, 1.53; 95% CI, 1.06–2.23; P=0.025).
4
Postoperative atrial fibrillation is associated with increased long-term cerebrovascular accident risk, challenging its characterization as a benign complication.
5
The association remained significant after excluding cerebrovascular accidents during the index admission (hazard ratio, 1.47; 95% CI, 1.02–2.11; P=0.04).
Research Object
Patients undergoing isolated coronary artery bypass graft surgery, with or without postoperative atrial fibrillation
Research Subject
The association of postoperative atrial fibrillation with the long-term risk of cerebrovascular accident (stroke)
Publication Details
Publication Date
2020-10-05
Journal
Publisher
ISSN
Open access PDF
Access Type
Author Information
Download PDF
Subscribe to digest