Postoperative atrial fibrillation and mortality after coronary artery bypass surgery
Open accessAbstract
Objectives We sought to determine if the occurrence of postoperative atrial fibrillation (AF) affects early or late mortality following coronary artery bypass surgery (CABG).Background Atrial fibrillation is the most common arrhythmia seen following CABG.Methods The Texas Heart Institute Cardiovascular Research Database was used to identify all patients that developed AF after isolated initial CABG from January 1993 to December 1999 (n = 994). This population was compared with patients who underwent CABG during the same period but did not develop AF (n = 5,481). In-hospital end points were adjusted using logistic regression models to account for baseline differences. Long-term survival was evaluated using a retrospective cohort design, where Cox proportional hazards methods were used to adjust for baseline differences, and with case-matched populations (n = 390, 195 per arm).Results Atrial fibrillation was diagnosed in 16% of the population. Postoperative AF was associated with greater in-hospital mortality (odds ratio [OR] 1.7, p = 0.0001), more strokes (OR 2.02, p = 0.001), prolonged hospital stays (14 vs. 10 days, p < 0.0001), and a reduced incidence of myocardial infarction (OR 0.62, p = 0.01). At four to five years, survival was worse in patients who developed postoperative AF (74% vs. 87%, p < 0.0001 in the retrospective cohort; 80% vs. 93%, p = 0.003 in the case-matched population). On multivariate analysis, postoperative AF was an independent predictor of long-term mortality (adjusted OR 1.5, p < 0.001 in the retrospective cohort; OR 3.4, p = 0.0018 in the case-matched population).Conclusions The occurrence of AF following CABG identifies a subset of patients who have a reduced survival probability following CABG. The impact of various strategies, such as antiarrhythmics and warfarin, aimed at reducing AF and its complications deserves further study.
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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 [957]
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- Authors
- Villareal, R. P., Hariharan, R., Liu, B. C., Kar, B., Lee, V.-V., Elayda, M., Lopez, J. A., Rasekh, A., Wilson, J. M., & Massumi, A.
- Affiliations
- Self Regional Healthcare (US)
- Baylor St. Luke's Medical Center (US)
- Corresponding author
- Villareal, Rollo P.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2004-03
- Volume
- 43
- Issue
- 5
- Pages
- 742-748
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2109784377
- Cited by
- 715
- References
- 24
- Citations by year
- 2026: 21 · 2025: 21 · 2024: 56 · 2023: 22 · 2022: 32 · 2021: 55 · 2020: 35 · 2019: 36 · 2018: 33 · 2017: 41 · 2016: 35 · 2015: 40 · 2014: 39 · 2013: 39 · 2012: 39
- FWCI
- 13.29
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- 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, mortality, long-term survival, stroke, length of hospital stay, myocardial infarction, antiarrhythmic therapy, warfarin
- MeSH terms
- Aged, Coronary Artery Bypass, Atrial Fibrillation, Cardiac Care Facilities, Female, Humans, Length of Stay, Male, Middle Aged, Myocardial Infarction, Retrospective Studies, Texas, Time Factors, Cohort Studies, Proportional Hazards Models, Survival Analysis, Hospital Mortality, Databases as Topic, Stroke
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