Usefulness of postoperative atrial fibrillation as an independent predictor for worse early and late outcomes after isolated coronary artery bypass grafting (multicenter Australian study of 19,497 patients)

Saxena, Akshat; Dinh, Diem T.; Smith, Julian A.; Shardey, Gilbert C.; Reid, Christopher M.; Newcomb, Andrew E.

doi:10.1016/j.amjcard.2011.08.033

Cited by 158Atrial Fibrillation Management and OutcomesCardiac and Coronary Surgery TechniquesCardiac, Anesthesia and Surgical Outcomes

Usefulness of postoperative atrial fibrillation as an independent predictor for worse early and late outcomes after isolated coronary artery bypass grafting (multicenter Australian study of 19,497 patients)

Saxena, Akshat, Dinh, Diem T., Smith, Julian A., Shardey, Gilbert C., Reid, Christopher M., Newcomb, Andrew E.·2012·The American Journal of Cardiology

DOI 10.1016/j.amjcard.2011.08.033

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Abstract

Several studies have shown that postoperative atrial fibrillation (POAF) is associated with poorer short- and long-term outcomes after isolated coronary artery bypass grafting surgery. Nevertheless, there is considerable debate as to whether this reflects an independent association of POAF with poorer outcomes or confounding by other factors. We sought to investigate this issue. Data obtained from June 2001 through December 2009 by the Australasian Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database Program were retrospectively analyzed. Demographic and operative data were compared between patients who developed POAF and those who did not using chi-square and t tests. The independent impact of POAF on 14 short-term complications and long-term mortality was determined using binary logistic and Cox regression, respectively. Excluding patients with preoperative arrhythmia, isolated coronary artery bypass grafting surgery was performed in 19,497 patients. Of these, 5,547 (28.5%) developed POAF. Patients with POAF were generally older (mean age 69 vs 65 years, p <0.001) and presented more often with co-morbidities including congestive heart failure (p <0.001), hypertension (p <0.001), cerebrovascular disease (p <0.001), and renal failure (p = 0.046). Patients with POAF demonstrated a greater 30-day mortality on univariate analysis but not on multivariate analysis (p = 0.376). Patients with POAF were, however, at an independently increased risk of perioperative complications including permanent stroke (p <0.001), new renal failure (p <0.001), infective complications (p <0.001), gastrointestinal complications (p <0.001), and return to the theater (p <0.001). POAF was also independently associated with shorter long-term survival (p = 0.002). In conclusion, POAF is a risk factor for short-term morbidity and decreased long-term survival. Rigorous evaluation of various therapies that prevent or decrease the impact of POAF is imperative. Moreover, patients who develop POAF should undergo strict surveillance and be routinely screened for complications after discharge.

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Postoperative AF is associated with an increased early stroke risk, increased morbidity, and 30-day mortality.
“Postoperative AF is associated with an increased early stroke risk, increased morbidity, and 30-day mortality.927,951,952”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [952]
In the long term, patients with an episode of postoperative AF have a twofold increase in cardiovascular mortality and a substantially increased risk of future AF and ischaemic stroke compared with patients that remain in sinus rhythm after surgery.
“In the long term, patients with an episode of postoperative AF have a twofold increase in cardiovascular mortality and a substantially increased risk of future AF and ischaemic stroke compared with patients that remain in sinus rhythm after surgery.952-958”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [952]

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Postoperative Atrial Fibrillation and Long-Term Outcomes After Isolated Coronary Artery Bypass Grafting
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Is Post-Operative Atrial Fibrillation an Independent Risk Factor for Worse Early and Late Outcomes After Isolated Coronary Artery Bypass Graft Surgery? A Multicentre Australian Study of 19497 Patients
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Assessment of the Risk Factors and Outcomes for Postoperative Atrial Fibrillation Patients Undergoing Isolated Coronary Artery Bypass Grafting.
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A high-risk perioperative atrial fibrillation phenotype and early outcomes after isolated coronary artery bypass grafting
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Authors: Saxena, A., Dinh, D. T., Smith, J. A., Shardey, G. C., Reid, C. M., & Newcomb, A. E.
Affiliations: St Vincent's Hospital Melbourne (AU)
Monash University (AU)
Monash Medical Centre (AU)
Cabrini Hospital (AU)
The University of Melbourne (AU)
Corresponding author: Saxena, Akshat
ORCID: Saxena, Akshat
Dinh, Diem T.
Smith, Julian A.
Reid, Christopher M.
Newcomb, Andrew E.
Venue: The American Journal of Cardiology
Publisher: Elsevier BV
Published: 2012-01
Volume: 109
Issue: 2
Pages: 219-225
ISSN: 0002-9149 (ISSN-L)
DOI: 10.1016/j.amjcard.2011.08.033
OpenAlex: W2059852786
Cited by: 158
References: 31
Citations by year: 2026: 2 · 2025: 7 · 2024: 13 · 2023: 8 · 2022: 14 · 2021: 18 · 2020: 12 · 2019: 12 · 2018: 10 · 2017: 15 · 2016: 13 · 2015: 11 · 2014: 9 · 2013: 8 · 2012: 6
FWCI: 5.04
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The American Journal of Cardiology (publishedVersion)
PubMed (publishedVersion)
eSpace (Curtin University) (submittedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
Keywords: postoperative atrial fibrillation, coronary artery bypass grafting, perioperative complications, 30-day mortality, long-term survival, risk factors, stroke, renal failure, infectious complications, confounding
MeSH terms: Aged, Coronary Artery Bypass, Atrial Fibrillation, Coronary Artery Disease, Electrocardiography, Female, Follow-Up Studies, Humans, Male, Middle Aged, Postoperative Complications, Prognosis, Retrospective Studies, Time Factors, Victoria, Incidence, Survival Rate, Treatment Outcome

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Usefulness of postoperative atrial fibrillation as an independent predictor for worse early and late outcomes after isolated coronary artery bypass grafting (multicenter Australian study of 19,497 patients)

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