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Randomized Controlled Trial
. 2020 Oct 6;142(14):1320-1329.
doi: 10.1161/CIRCULATIONAHA.120.046940. Epub 2020 Oct 5.

Postoperative Atrial Fibrillation and Long-Term Risk of Stroke After Isolated Coronary Artery Bypass Graft Surgery

Umberto Benedetto  1 , Mario F Gaudino  2 , Arnaldo Dimagli  1 , Stephen Gerry  3 , Alastair Gray  4 , Belinda Lees  5 , Marcus Flather  6 , David P Taggart  5 ; ART Investigators*
Collaborators, Affiliations
Randomized Controlled Trial

Postoperative Atrial Fibrillation and Long-Term Risk of Stroke After Isolated Coronary Artery Bypass Graft Surgery

Umberto Benedetto et al. Circulation. .

Abstract

Background: Postoperative atrial fibrillation (pAF) after coronary artery bypass grafting is a common complication. Whether pAF is associated with an increased risk of cerebrovascular accident (CVA) remains uncertain. We investigated the association between pAF and long-term risk of CVA by performing a post hoc analysis of 10-year outcomes of the ART (Arterial Revascularization Trial).

Methods: For the present analysis, among patients enrolled in the ART (n=3102), we excluded those who did not undergo surgery (n=25), had a history of atrial fibrillation (n=45), or had no information on the incidence of pAF (n=9). The final population consisted of 3023 patients, of whom 734 (24.3%) developed pAF with the remaining 2289 maintaining sinus rhythm. Competing risk and Cox regression analyses were used to investigate the association between pAF and the risk of CVA.

Results: At 10 years, the cumulative incidence of CVA was 6.3% (4.6%-8.1%) versus 3.7% (2.9%-4.5%) in patients with pAF and sinus rhythm, respectively. pAF was an independent predictor of CVA at 10 years (hazard ratio, 1.53 [95% CI, 1.06-2.23]; P=0.025) even when CVAs that occurred during the index admission were excluded from the analysis (hazard ratio, 1.47 [95% 1.02-2.11]; P=0.04).

Conclusions: Patients with pAF after coronary artery bypass grafting are at higher risk of CVA. These findings challenge the notion that pAF is a benign complication.

Keywords: atrial fibrillation; coronary artery bypass; stroke.

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Conflict of interest statement

Disclosure: authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Cumulative incidence of cerebrovascular accident (CVA) in patients with postoperative atrial fibrillation (pAF) and stable sinus rhythm (SR) (Panel A) in the overall sample. Cumulative incidence of CVA in patients with pAF and stable SR after discharge (i.e. CVA that occurred during index hospitalization were excluded) (Panel B).
Figure 2.
Figure 2.
Cumulative incidence of cardiovascular (CV) deaths in patients with postoperative atrial fibrillation (pAF) and stable sinus rhythm (SR) (Panel A). Cumulative incidence of all-cause deaths in patients with pAF and stable SR (Panel B).
Figure 3.
Figure 3.
Cumulative incidence of cerebrovascular accident (CVA) with postoperative atrial fibrillation (pAF) and stable sinus rhythm (SR) stratified by CHA2DS2VASc < 4 or ≥4.
See this image and copyright information in PMC

References

    1. Mathew JP, Fontes ML, Tudor IC, Ramsay J, Duke P, Mazer CD, Barash PG, Hsu PH, Mangano DT Investigators of the Ischemia Research and Education Foundation; Multicenter Study of Perioperative Ischemia Research Group. A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA. 2004; 291:1720–1729 - PubMed
    1. Greenberg JW, Lancaster TS, Schuessler RB, Melby SJ. Postoperative atrial fibrillation following cardiac surgery: a persistent complication. Eur J Cardiothorac Surg. 2017; 52:665–672. - PubMed
    1. Saxena A, Dinh DT, Smith JA, Shardey GC, Reid CM, Newcomb AE. 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). Am J Cardiol. 2012;109:219–225. - PubMed
    1. El-Chami MF, Kilgo P, Thourani V, Lattouf OM, Delurgio DB, Guyton RA, Leon AR, Puskas JD New-onset atrial fibrillation predicts long-term mortality after coronary artery bypass graft. J Am Coll Cardiol. 2010;55:1370–1376. - PubMed
    1. Mariscalco G, Klersy C, Zanobini M, Banach M, Ferrarese S, Borsani P, Cantore C, Biglioli P, Sala A Atrial fibrillation after isolated coronary surgery affects late survival. Circulation. 2008;118:1612–1618 - PubMed

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