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. 2024 Aug 1;7(8):e2426865.
doi: 10.1001/jamanetworkopen.2024.26865.

Sex, Atrial Fibrillation, and Long-Term Mortality After Cardiac Surgery

Sergey Karamnov  1 , Natalia Sarkisian  2 , Jakob Wollborn  1 , Samuel Justice  1 , Kara Fields  1 , Vesela P Kovacheva  1 , Asishana A Osho  3 , Ashraf Sabe  4 , Simon C Body  5 , Jochen D Muehlschlegel  6
Affiliations

Sex, Atrial Fibrillation, and Long-Term Mortality After Cardiac Surgery

Sergey Karamnov et al. JAMA Netw Open. .

Abstract

Importance: There are limited data on the association of sex with the incidence of postoperative atrial fibrillation (poAF) and subsequent long-term mortality after cardiac surgery.

Objective: To evaluate whether the incidence of poAF and associated long-term mortality after cardiac surgery differ by sex.

Design, setting, and participants: This retrospective cohort study was conducted at 2 tertiary care centers in Massachusetts from January 1, 2002, until October 1, 2016, with follow-up until December 1, 2022. Adult (aged >20 years) women and men undergoing coronary artery bypass graft surgery, aortic valve surgery, mitral valve surgery, and combined procedures with cardiopulmonary bypass were examined using medical records. Patients who had data on poAF were included in data analyses.

Exposures: Sex and poAF.

Main outcomes and measures: Primary outcomes were the incidence of poAF and all-cause mortality. poAF was defined as any atrial fibrillation detected on electrocardiogram (EKG) during the index hospitalization in patients presenting for surgery in normal sinus rhythm. Data on poAF were obtained from EKG reports and supplemented by information from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. All-cause mortality was assessed via hospital records. The hypotheses were formulated prior to data analysis.

Results: Among 21 568 patients with poAF data (mean [SD] age, 66.5 [12.4] years), 2694 of 6601 women (40.8%) and 5805 of 14 967 men (38.8%) developed poAF. In a multivariable logistic regression model, women had lower risk of poAF (odds ratio [OR], 0.85; 95% CI, 0.79-0.91; P < .001). During the follow-up study period, 1294 women (50.4%) and 2376 men (48.9%) in the poAF group as well as 1273 women (49.6%) and 2484 men (51.1%) in the non-poAF group died. Cox proportional hazards analysis found that the association between poAF and mortality was significantly moderated (ie, effect modified) by sex. Compared with same-sex individuals without poAF, men with poAF had a 17% higher mortality hazard (hazard ratio [HR], 1.17; 95% CI, 1.11-1.25; P < .001), and women with poAF had a 31% higher mortality hazard (HR, 1.31; 95% CI, 1.21-1.42; P < .001).

Conclusions and relevance: In this retrospective cohort study of 21 568 patients who underwent cardiac surgery, women were less likely to develop poAF than men when controlling for other relevant characteristics; however, women who did develop poAF had a higher risk of long-term mortality than men who developed poAF. This observed elevated risk calls for a tailored approach to perioperative care in women undergoing cardiac surgery.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Karamnov reported receiving personal fees from Covidien and UptoDate and owning stock in Verastem and Ibio outside the submitted work. Dr Kovacheva reported receiving personal fees from Avania outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flow Diagram of the Study With Inclusion and Exclusion Criteria
AF indicates atrial fibrillation; AVR, aortic valve replacement; BWH, Brigham and Women’s Hospital; CABG, coronary artery bypass surgery; LAAO, left atrial appendage occlusion; MGH, Massachusetts General Hospital; MVR, mitral valve replacement or repair; and PVI, pulmonary vein isolation. aSome records had multiple, overlapping exclusions.
Figure 2.
Figure 2.. Covariate-Adjusted Mortality in All Patients Who Underwent Open Heart Surgery Between January 1, 2002, and October 1, 2016, in 2 Tertiary Care Centers, by Sex and Presence of Postoperative Atrial Fibrillation (poAF)
Hazard ratios when compared with male patients without poAF are as follows: female patients without poAF: HR, 1.07 (95% CI, 0.99-1.15); male patients with poAF: HR, 1.17 (95% CI, 1.11-1.24); female patients with poAF: 1.40 (95% CI, 1.31-1.51).
See this image and copyright information in PMC

Comment in

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