Preoperative atrial fibrillation in elderly patients undergoing CABG significantly increased the combined endpoint of death, infarction, stroke, dialysis, and revascularization (13% vs 8%, P=0.008).
RCT (n=2,303)
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Does off-pump CABG improve outcomes compared to on-pump CABG in elderly patients with preoperative atrial fibrillation?
Preoperative atrial fibrillation increases the risk of adverse outcomes in elderly patients undergoing CABG, and this risk is not mitigated by using an off-pump surgical technique.
Tasa de eventos absoluta: 13% vs 8%
valor p: p=0.008
OBJECTIVES: Patients undergoing coronary bypass grafting (CABG) are at higher risk if they suffer from atrial fibrillation (AF). It was suggested that performing CABG without the use of cardiopulmonary bypass (off-pump) would reduce perioperative risk. We assessed the influence of preoperative AF on outcome in a randomized cohort of patients above the age of 75 undergoing either on-pump or off-pump CABG. METHODS: The German Off-Pump Coronary Artery Bypass grafting in the Elderly trial, a randomized, controlled multicentre trial conducted at 12 German institutions, enrolled 2303 patients between 2008 and 2011. The presence of AF was recorded at admission and discharge. There was no record on the rhythm status during hospital stay. RESULTS: AF at admission was present in 5% in the on-pump (121/1158) and 5% in the off-pump (112/1145) group. The number of patients with AF at discharge was not different between these two groups (10% on pump, 10% off pump). As expected, AF patients had worse preoperative conditions, which had a negative impact on outcome: The combined end-point of death, infarction, stroke, dialysis and revascularization occurred more often (13 vs 8%, P = 0.008) and 30-day mortality was significantly higher (6 vs 2%, P = 0.003) in AF patients. However, the operative technique used for CABG did not affect these outcome parameters. CONCLUSIONS: AF at admission is a significant risk factor for elderly patients undergoing coronary bypass grafting. However, this risk is not altered by performing bypass grafting off pump.
Böning et al. (Wed,) conducted a rct in Coronary artery disease requiring CABG (n=2,303). Preoperative atrial fibrillation vs. No preoperative atrial fibrillation was evaluated on Combined end-point of death, infarction, stroke, dialysis and revascularization (p=0.008). Preoperative atrial fibrillation in elderly patients undergoing CABG significantly increased the combined endpoint of death, infarction, stroke, dialysis, and revascularization (13% vs 8%, P=0.008).