Key result
POAF after MIDCAB is linked to 4% early mortality but not 5-year MACE.
Why the study?
The risk factors and mid-term outcomes of postoperative atrial fibrillation after minimally invasive direct coronary artery bypass were not well characterized.
Does postoperative atrial fibrillation after minimally invasive direct coronary artery bypass increase the risk of major adverse cardiac events?
Cohort (n=165)
No
Does postoperative atrial fibrillation after minimally invasive direct coronary artery bypass increase the risk of major adverse cardiac events?
Postoperative atrial fibrillation after MIDCAB is associated with increased early postoperative morbidity and mortality, but does not significantly impact mid-term major adverse cardiac events at 5 years.
POAF after MIDCAB signals higher early mortality risk; leaves open independent link to 5-year MACE.
OBJECTIVE: To evaluate the risk factors and explore the mid-term outcomes of postoperative atrial fibrillation (POAF) after minimally invasive direct coronary artery bypass (MIDCAB). METHODS: A total of 165 patients, who underwent isolated MIDCAB from 2012 to 2015, were enrolled in the study and retrospectively reviewed. Patients with preoperative arrhythmia, concomitant surgical procedures were excluded. All patients were continuously monitored for POAF until discharge, and two groups were formed: the non-POAF group (140 patients, 71.4% men, mean age 58.83±10.3 years) and the POAF group (25 patients, 84.0% men, mean age 64.52±9.0 years). Early and mid-term outcomes were evaluated, perioperative factors associated with POAF were analyzed with a binary logistic regression model, and the relationship between POAF and major adverse cardiac event (MACE) was analyzed with Cox regression model. RESULTS: The incidence of POAF in this study was 15.15%. Patients in the POAF group had a significant higher risk of re-entry to ICU (2 cases: 2 cases=8.0%: 1.4%, P = 0.049), renal failure (2 cases: 1 case=8.0%: 0.7%, P = 0.018), and death (1 case: 0 case=4.0%: 0%, P = 0.018). Binary logistic regression showed gender (male), age were independent risk factors of POAF (P = 0.038, 95% confidence interval 1.082-16.286; P = 0.011, 95% confidence interval 1.015-1.117, respectively), preoperative ACEI or ARB usage was a protective factor of POAF (P = 0.010, 95% confidence interval 0.113-0.748). With a 5-year follow up, the overall MACE rate showed no statistical difference between the two groups (P = 0.067). CONCLUSIONS: POAF after MIDCAB was related to postoperative morbidities, such as re-entry to ICU, renal failure, and death. Gender (male) and age were independent risk factors, while preoperative ACEI or ARB usage was a protective factor. POAF has not associated the occurrence of MACE with a mid-term follow-up.
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Fan et al. (2021) conducted a cohort in Postoperative atrial fibrillation after minimally invasive direct coronary artery bypass (n=165). Postoperative atrial fibrillation (POAF) vs. No postoperative atrial fibrillation was evaluated on Major adverse cardiac event (MACE) (p=0.067). Postoperative atrial fibrillation after MIDCAB was associated with early death (4.0% vs 0%, P=0.018) but not significantly associated with major adverse cardiac events at 5 years (P=0.067).
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