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. 2024 May;117(5):942-949.
doi: 10.1016/j.athoracsur.2023.11.034. Epub 2023 Dec 13.

Concomitant Treatment of Atrial Fibrillation in Isolated Coronary Artery Bypass Grafting

J Hunter Mehaffey  1 , J W Awori Hayanga  2 , Lawrence M Wei  2 , Dhaval Chauhan  2 , Christopher E Mascio  2 , J Scott Rankin  2 , Vinay Badhwar  2
Affiliations

Concomitant Treatment of Atrial Fibrillation in Isolated Coronary Artery Bypass Grafting

J Hunter Mehaffey et al. Ann Thorac Surg. 2024 May.

Abstract

Background: Societal guidelines support concomitant management of atrial fibrillation (AF) in patients undergoing cardiac surgery. To assess real-world adoption and outcomes, this study evaluated Medicare beneficiaries with AF who underwent isolated coronary artery bypass grafting (CABG) with surgical ablation (SA) or left atrial appendage obliteration (LAAO) or both procedures in combination (SA + LAAO).

Methods: The US Centers for Medicare & Medicaid Services inpatient claims database identified all patients with AF who underwent isolated CABG from 2018 to 2020. Diagnosis-related group and International Classification of Diseases-10th revision procedure codes defined covariates for doubly robust risk adjustment.

Results: A total of 19,524 patients with preoperative AF who underwent isolated CABG were stratified by SA + LAAO (3475 patients; 17.8%), LAAO only (4541 patients; 23.3%), or no AF treatment (11,508 patients; 58.9%). After doubly robust risk adjustment, longitudinal analysis highlighted that concomitant AF treatment with SA + LAAO (hazard ratio [HR], 0.74; P = .049) or LAAO alone (HR, 0.75; P = . 031) was associated with a significant reduction in readmission for stroke at 3 years compared with no AF treatment. Furthermore, SA + LAAO (HR, 0.86; P = .016) but not LAAO alone (HR, 0.97; P = .573) was associated with improved survival compared with no AF treatment. Finally, SA + LAAO was associated with a superior composite outcome of freedom from stroke or death at 3 years compared with LAAO alone (HR, 0.86;, P = .033) or no AF treatment (HR, 0.81; P = .001).

Conclusions: In Medicare beneficiaries with AF who underwent isolated CABG, concomitant AF treatment was associated with reduced 3-year readmission for stroke. SA + LAAO was associated with superior reduction in stroke or death at 3 years compared with LAAO alone or no AF treatment.

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Conflict of interest statement

Declaration of interests

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:

Figures

Figure 1:
Figure 1:
Concomitant Atrial Fibrillation Treatment. Pie charts illustrating the rate of concomitant Atrial Fibrillation treatment A. Overall, B. Persistent Atrial Fibrillation Cohort and C. Paroxysmal Atrial Fibrillation Cohort with SA+LAAO (Green), LAAO Alone (Blue) and no AF treatment (Red).
Figure 2:
Figure 2:
Unadjusted A. Survival and B. Time to Composite Curves. Risk adjusted Kaplan Meier survival curves stratified by treatment group SA+LAAO (Green), LAAO Alone (Red) and no AF treatment (Blue).
Figure 3:
Figure 3:
Balance Plot. Highlights the pre and post adjustment weighted standard means of the Inverse probability of treatment weighting. Utilized to account for the significant differences in baseline patient variables across the groups.
Figure 4:
Figure 4:
A. Risk Adjusted Survival Entire Cohort B. Risk Adjusted Composite. Risk adjusted Kaplan Meier survival curves stratified by treatment group SA+LAAO (Green), LAAO Alone (Blue) and no AF treatment (Red).
See this image and copyright information in PMC

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