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Meta-Analysis
. 2017 Dec 22;6(12):e007558.
doi: 10.1161/JAHA.117.007558.

New-Onset Atrial Fibrillation After Coronary Artery Bypass Graft and Long-Term Risk of Stroke: A Meta-Analysis

Matthew R Megens  1   2 , Leonid Churilov  1   2 , Vincent Thijs  3   4
Affiliations
Meta-Analysis

New-Onset Atrial Fibrillation After Coronary Artery Bypass Graft and Long-Term Risk of Stroke: A Meta-Analysis

Matthew R Megens et al. J Am Heart Assoc. .

Abstract

Background: New-onset atrial fibrillation (NOAF) after coronary artery bypass graft is related to an increased short-term risk of stroke and mortality. We investigated whether the long-term risk of stroke is increased.

Methods and results: We performed a systematic review and meta-analysis of studies that included patients who had coronary artery bypass graft and who afterwards developed NOAF during their index admission; these patients did not have previous atrial fibrillation. The primary outcome was risk of stroke at 6 months or more in patients who developed NOAF compared with those who did not. Odds ratios, relative risk, and hazard ratios were considered equivalent; outcomes were pooled on the log-ratio scale using a random-effects model and reported as exponentiated effect-sizes. We included 16 studies, comprising 108 711 participants with a median follow-up period of 2.05 years. Average participant age was 66.8 years, with studies including an average of 74.8% males. There was an increased long-term risk of stroke in the presence of NOAF (unadjusted studies effect-sizes=1.36, 95% confidence interval, 1.12-1.65, P=0.001, adjusted studies effect-sizes=1.25, 95% confidence interval, 1.09-1.42, P=0.001). There was evidence of moderate effect variation because of heterogeneity in studies reporting unadjusted (P=0.021, I2=49.8%) and adjusted data (P=0.081, I2=49.1%), and publication bias in the latter group (Egger's test, P=0.031). Sensitivity analysis on unadjusted data by study quality, design, and surgery did not alter the effect direction.

Conclusions: Presence of NOAF in patients post-coronary artery bypass graft is associated with increased long-term risk of stroke compared with patients without NOAF. Further studies may show whether the increased risk is mediated by atrial fibrillation and whether anticoagulation reduces risk.

Keywords: atrial fibrillation; coronary artery bypass surgery; coronary artery graft surgery; meta‐analysis; stroke; systematic review.

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Figures

Figure 1
Figure 1
Study selection flowchart. inc/exc indicates inclusion/exclusion.
Figure 2
Figure 2
A and B, Forest plots (unadjusted and adjusted outcomes)—overall increased risk of stroke associated with new‐onset atrial fibrillation, by both random effects (D+L) and fixed‐effects (I‐V) analysis. CI indicates confidence interval; ES, effect size.
Figure 3
Figure 3
A and B, Funnel plots (unadjusted and adjusted outcomes). PE indicates point estimate; s.e., standard error.
Figure 4
Figure 4
Sensitivity analysis (unadjusted outcomes). ES indicates effect size; CI, confidence interval.
See this image and copyright information in PMC

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