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New-onset atrial fibrillation following coronary bypass surgery predicts long-term mortality: a systematic review and meta-analysis
Abstract
Atrial fibrillation (AF) is one of the most common postoperative complications following cardiac surgery. Recent evidence suggests that postoperative atrial fibrillation (POAF) may be more 'malignant' than previously thought, associated with follow-up mortality and morbidity. To evaluate the long-term survival of POAF versus No-POAF cohorts following coronary bypass surgery, the current meta-analysis with reconstructed individual patient data was performed. Electronic searches were performed using six databases from their inception to August 2014. Relevant studies with long-term survival data presented for POAF versus No-POAF were identified. Data were extracted by two independent reviewers and analysed according to predefined clinical endpoints. The pooled hazard ratio (HR) significantly favoured higher survival in No-POAF over POAF (HR 1.28; 95% CI, 1.19-1.37; I(2) = 96%; P < 0.00001). Individual patient data of 69 518 patients were available for inverted Kaplan-Meier survival curve analysis. Analysis of aggregate data using Kaplan-Meier curve methods for POAF versus No-POAF groups determined survival rates at the 1-year (95.7 vs 98%), 2-year (92.3 vs 95.4%), 3-year (88.7 vs 93.9%), 5-year (82.6 vs 89.4%) and 10-year (65.5 vs 75.3%) follow-up. Other complications including 30-day mortality, strokes, respiratory failure, pneumonia and hospitalization were significantly higher in the POAF group. New-onset AF following coronary bypass surgery is associated with significantly higher risk of mortality in short- and long-term follow-up. Current evidence suggests the need for stricter surveillance and monitoring of POAF following coronary bypass surgery.
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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.952-958”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [958]
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Metadata
- Authors
- Phan, K., Ha, H. S. K., Phan, S., Medi, C., Thomas, S. P., & Yan, T. D.
- Affiliations
- Westmead Hospital (AU)
- UNSW Sydney (AU)
- Collaborative Research Group (AU)
- The University of Sydney (AU)
- Corresponding author
- Yan, Tristan D.
- Venue
- European Journal of Cardio-Thoracic Surgery
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-01-18
- Volume
- 48
- Issue
- 6
- Pages
- 817-824
- ISSN
- 1010-7940 (ISSN-L)
- 1873-734X
- OpenAlex
- W2006452581
- Cited by
- 143
- References
- 43
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 13 · 2023: 16 · 2022: 12 · 2021: 18 · 2020: 20 · 2019: 17 · 2018: 4 · 2017: 11 · 2016: 11 · 2015: 5
- FWCI
- 1.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Cardio-Thoracic Surgery (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, long-term mortality, postoperative complications, cardiac surgery, stroke, respiratory failure, pneumonia, hospitalization, postoperative follow-up
- MeSH terms
- Coronary Artery Bypass, Atrial Fibrillation, Humans, Survival Analysis, Kaplan-Meier Estimate
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