Prognostic Impact of Preoperative Atrial Fibrillation in Patients Undergoing Heart Surgery in Cardiogenic Shock

Background Surgical intervention in the setting of cardiogenic shock (CS) is burdened with high mortality. Due to acute condition, detailed diagnoses and risk assessment is often precluded. Atrial fibrillation (AF) is a risk factor for perioperative complications and worse survival but little is known about AF patients operated in CS. Current analysis aimed to determine prognostic impact of preoperative AF in patients undergoing heart surgery in CS. Methods We analyzed data from the Polish National Registry of Cardiac Surgery (KROK) Procedures. Between 2012 and 2021, 4,852 patients presented with CS and were referred for cardiac surgery in 37 centers. Total of 624 (13%) patients had AF history. Cox proportional hazards models were used for computations. Propensity score (nearest neighbor) matching for the comparison of patients with and without AF was performed. Results Median follow-up was 4.6 years (max.10.0), mean age was 62 (±15) years and 68% patients were men. Thirty-day mortality was 36%. The origin of CS included acute myocardial infarction (36%), acute aortic dissection (22%) and valvular dysfunction (13%). In an unadjusted analysis, patients with underlying AF had almost 20% higher mortality risk (HR 1.19, 95% CIs 1.06-1.34; P=0.004). Propensity score matching returned 597 pairs with similar baseline characteristics; AF remained a significant prognostic factor for worse survival (HR 1.19, 95% CI 1.00-1.40; P=0.045). Conclusions Among patients with CS referred for cardiac surgery, history of AF was a significant risk factor for mortality. Role of concomitant AF ablation and/or left atrial appendage occlusion should be addressed in the future.