• Laila Al-Shaar, Thomas A Schwann, Ameer Kabour, and Robert H Habib.
• Vascular Medicine Program, American University of Beirut, Beirut, Lebanon.
• J. Thorac. Cardiovasc. Surg.. 2014 Nov 1;148(5):1860-1868.e2.

ObjectivesThe association of new-onset postoperative atrial fibrillation (POAF) and late death after coronary artery bypass grafting (CABG) has been confounded by the frequent concomitant serious complications that co-occur with POAF. We aimed to define the magnitude and time dependence of the effect of isolated POAF on late survival after uncomplicated CABG to comprehensively account for comorbidity and perioperative confounding factors.MethodsNonsalvage CABG patients with no history of AF, no concomitant aortic or valvular surgery, and no perioperative complications other than POAF were studied (n=6305). Patients were divided into AF (n=1211, 68 years old, 72% male) and no-AF (n=5094, 63 years old, 70% male) groups. Propensity matching was done using 55 patient variables, including coronary grafts, completeness of revascularization, and transfusion data. The AF effect was quantified using time-segmented hazard ratios by Cox regression analysis.ResultsSingle (1-to-1), double (1-to-2), and triple (1-to-3) propensity matching of the AF and no-AF was achieved for 1196, 993, and 719 cases, respectively. The AF group showed significantly worse, yet time-varying, 0- to 18-year survival: 0 to 1 year, HR, 1.18 (95% confidence interval, 0.77-1.81); 1 to 6 years, HR, 1.37 (95% confidence interval, 1.12 to 1.67); and 6 to 17 years, HR, 1.25 (95% confidence interval, 1.05 to 1.49).ConclusionsIsolated POAF was associated with a time-varying increase in mortality after CABG. Given these findings and the high incidence of POAF, efforts to reduce POAF should be pursued to potentially improve resource usage, morbidity, and mortality.Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

21 keywords...

hide…