What question did this study set out to answer?

To assess the long-term effects of pre- and postoperative atrial fibrillation on cause-specific and overall mortality in patients undergoing aortocoronary bypass surgery.

September 10, 2016Scandinavian Cardiovascular JournalOpen Access

Pre- and postoperative atrial fibrillation in CABG patients have similar prognostic impact

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Why the study?

Does pre- or postoperative atrial fibrillation increase long-term mortality and cardiovascular death in patients undergoing aortocoronary bypass surgery?

Key Points

To assess the long-term effects of pre- and postoperative atrial fibrillation on cause-specific and overall mortality in patients undergoing aortocoronary bypass surgery.
Studied a cohort of 615 patients who underwent aortocoronary bypass graft surgery in 1999–2000.
Stratified patients into preoperative atrial fibrillation (n=44, 7%), postoperative atrial fibrillation (n=165, 27%), and no atrial fibrillation (n=406, 66%).
Recorded symptoms, medications, and cause of death over a median follow-up of 15 years.
Both preoperative and postoperative atrial fibrillation independently predicted late mortality (HR 1.47, 95% CI 1.02–2.12 and HR 1.28, 95% CI 1.01–1.63, respectively).
Cerebral ischaemic death was significantly higher in preoperative (7%) and postoperative (5%) atrial fibrillation groups compared to those without atrial fibrillation (2%, p = .038).
Deaths due to heart failure (18% and 14% vs. 7%, p = .007) and sudden death (9% and 5% vs. 2%, p = .029) occurred more frequently in patients with pre- or postoperative atrial fibrillation.

Structured PICO

Does pre- or postoperative atrial fibrillation increase long-term mortality and cardiovascular death in patients undergoing aortocoronary bypass surgery?

Population

615 patients undergoing aortocoronary bypass graft surgery in 1999-2000.

Intervention

Presence of preoperative atrial fibrillation (n=44) or postoperative atrial fibrillation (n=165)

Comparator

No atrial fibrillation (n=406)

Outcome

Late mortality and cause of death (cerebral ischaemia, heart failure, sudden death) at median 15 years follow-uphard clinical

Both pre- and postoperative atrial fibrillation in CABG patients are associated with similarly increased risks of long-term mortality, heart failure death, and cerebral ischemia compared to patients who remain in sinus rhythm.

Implication

AF around CABG signals need for vigilant long-term monitoring; leaves open whether targeted rhythm strategies improve outcomes.

Abstract

OBJECTIVES: To study pre- and postoperative atrial fibrillation and its long-term effects in a cohort of aortocoronary bypass surgery patients. DESIGN: Altogether 615 patients undergoing aortocoronary bypass graft surgery in 1999-2000 were studied. Forty-four (7%) had preoperative atrial fibrillation. Postoperative atrial fibrillation occurred in 165/615 patients (27%) while 406/615 patients (66%) had no atrial fibrillation. After a median follow-up of 15 years, symptoms and medication in survivors were recorded, and cause of death in the deceased was obtained. RESULTS: Death due to cerebral ischaemia was most common in the pre- and postoperative atrial fibrillation groups (7% and 5%, respectively, v. 2% among those without atrial fibrillation, p = .038), as were death due to heart failure (18% and 14%, v. 7%, p = .007) and sudden death (9% and 5%, v. 2%, p = .029). The presence of pre- or postoperative atrial fibrillation was an independent risk factor for late mortality (hazard ratios 1.47 (1.02-2.12) and 1.28 (1.01-1.63), respectively). CONCLUSIONS: Patients with pre- or postoperative atrial fibrillation undergoing aortocoronary bypass surgery have increased long-term mortality and risk of cerebral ischemic and cardiovascular death compared with patients in sinus rhythm.