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Meta-Analysis
. 2025 Jun 18;20(1):265.
doi: 10.1186/s13019-025-03504-9.

Early postoperative atrial fibrillation is associated with late mortality after cardiac surgery: a systematic review and reconstructed individual patient data meta-analysis

Michal J Kawczynski #  1   2   3 , Claudia A J van der Heijden #  4 , Jos G Maessen  1   3 , Ulrich Schotten  2   3 , Mariusz Kowalewski  3   5 , Piotr Suwalski  5 , Elham Bidar #  1   3 , Bart Maesen #  6   7
Affiliations
Meta-Analysis

Early postoperative atrial fibrillation is associated with late mortality after cardiac surgery: a systematic review and reconstructed individual patient data meta-analysis

Michal J Kawczynski et al. J Cardiothorac Surg. .

Abstract

Background: Early postoperative atrial fibrillation (early-POAF) is the most common complication after cardiac surgery. Although prior studies have demonstrated an association between early-POAF and late outcomes, it is questionable whether these long-term adverse events result from early-POAF or from comorbidities that underlie the development of early-POAF. Therefore, the aim of this study was to investigate the association of early-POAF with late mortality and stroke after adjustment for age and cardiovascular comorbidities.

Methods: A systematic search was conducted to identify studies reporting on late mortality after cardiac surgery in patients with and without early-POAF. Articles presenting Kaplan-Meier were included for a pooled analysis of late mortality (primary outcome) and stroke (secondary outcome). Individual time-to-event data were reconstructed from the Kaplan-Meier curves and incorporated into a multivariable mixed-effects Cox model.

Results: In total, 33 studies were included in the analysis for late mortality (131 031 patients) and 10 studies in the analysis for late stroke (42 042 patients). Overall, 36 991 patients had early-POAF with a pooled incidence of 31.5% (95% CI: 27.7 to 35.6%). Unadjusted analysis showed that early-POAF was significantly associated with late mortality (Hazard Ratio [HR] = 1.62, 95%CI: 1.58-1.67, P < 0.001) and late stroke (HR = 1.72, 95%CI: 1.61-1.85, P < 0.001). Early-POAF was significantly associated with late mortality (adjusted HR = 1.19, 95% CI: 1.07-1.33, P = 0.002), but not with late stroke (adjusted HR = 1.14, 95% CI: 0.96-1.35, P = 0.122) after adjustment for age, comorbidities, surgery type, and the random effects term.

Conclusion: Early-POAF after cardiac surgery is significantly associated with late mortality, but not with late stroke, after adjustments for age, sex, cardiovascular comorbidities, and type of surgery.

Keywords: Cardiac surgery; Long-term outcomes; Meta-analysis; Postoperative atrial fibrillation.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study inclusion diagram
Fig. 2
Fig. 2
Hazard plots for late mortality and late stroke. A. Unadjusted late mortality in patients with and without POAF. B. Unadjusted late stroke in patients with and without POAF
Fig. 3
Fig. 3
Hazard plots for late mortality and late stroke for different surgical procedures. A Unadjusted late mortality hazard in patients with and without POAF undergoing CABG. B Unadjusted late mortality hazard in patients with and without POAF undergoing other cardiac procedures. C Unadjusted late stroke hazard in patients with and without POAF undergoing CABG. D Unadjusted late stroke hazard in patients with and without POAF undergoing other cardiac procedures
See this image and copyright information in PMC

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