Key result
Postoperative AF after CABG is not associated with increased long-term all-cause mortality.
Why the study?
The impact of postoperative atrial fibrillation after coronary artery bypass grafting on long-term clinical outcomes remains controversial.
Does postoperative atrial fibrillation increase the risk of long-term adverse clinical outcomes in patients undergoing CABG without prior atrial fibrillation?
Cohort (n=1,483)
Yes
Does postoperative atrial fibrillation increase the risk of long-term adverse clinical outcomes in patients undergoing CABG without prior atrial fibrillation?
Hazard Ratio: 0.96 (95% CI 0.7–1.31)
Absolute Event Rate: 15.9% vs 13%
p-value: p=0.81
Postoperative atrial fibrillation after CABG is associated with an increased long-term risk of major bleeding, but not all-cause mortality, highlighting the need for careful evaluation of anticoagulation strategies in this population.
POAF after CABG was associated with higher major bleeding risk without mortality difference; leaves open optimal anticoagulation strategies pending randomized trials.
BACKGROUND: The impact of postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) on long-term clinical outcomes remains controversial. METHODS AND RESULTS: Of 14,927 consecutive patients with their first coronary revascularization in the CREDO-Kyoto Registry Cohort-3, we extracted data for 1,483 undergoing CABG without prior atrial fibrillation (AF). POAF was defined as newly documented AF during hospitalization for CABG and was diagnosed in 337 (23%) patients during the index hospitalization. The remaining 1,146 patients were categorized as the non-POAF group. The median follow-up after discharge was 5.7 years. The cumulative 5-year incidence of all-cause death did not differ significantly between the POAF and non-POAF groups (15.9% vs. 13.0%, respectively; P=0.38), whereas the cumulative 5-year incidence of stroke, heart failure, and Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding was significantly higher in the POAF group. There was no excess adjusted risk of the POAF group relative to the non-POAF group for all-cause death (hazard ratio 0.96; 95% confidence interval 0.70-1.31; P=0.81). The risk of the POAF group relative to the non-POAF group was numerically higher for stroke and heart failure, and significantly higher for BARC type 3 or 5 bleeding. CONCLUSIONS: The long-term risk of patients with POAF relative to those without was significantly higher for major bleeding and numerically higher for stroke and heart failure, with no difference for mortality.
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Kuroda et al. (2025) conducted a cohort in Coronary artery disease requiring coronary artery bypass grafting (n=1,483). Postoperative atrial fibrillation (POAF) vs. No postoperative atrial fibrillation (Non-POAF) was evaluated on All-cause death after discharge (HR 0.96, 95% CI 0.70-1.31, p=0.81). Postoperative atrial fibrillation after coronary artery bypass grafting was not associated with an increased long-term risk of all-cause mortality (adjusted HR 0.96) compared to patients without POAF.
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