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Implications of new-onset atrial fibrillation after cardiac surgery on long-term prognosis: a community-based study.
Implications of new-onset atrial fibrillation after cardiac surgery on long-term prognosis: a community-based study.
- Source :
-
American heart journal [Am Heart J] 2015 Oct; Vol. 170 (4), pp. 659-68. Date of Electronic Publication: 2015 Jun 28. - Publication Year :
- 2015
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Abstract
- Background: Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery. Data are lacking on the long-term prognostic implications of POAF. We hypothesized that POAF, which reflects underlying cardiovascular pathophysiologic substrate, is a predictive marker of late AF and long-term mortality.<br />Methods: We identified 603 Olmsted County, Minnesota, residents without prior documented history of AF who underwent coronary artery bypass graft and/or valve surgery from 2000 to 2005. Patients were monitored for first documentation of late AF or death at >30 days postoperatively. Multivariate Cox regression models were used to assess the independent association of POAF with late AF and long-term mortality.<br />Results: After a mean follow-up of 8.3 ± 4.2 years, freedom from late AF was less with POAF than no POAF (57.4% vs 88.9%, P < .001). The risk of late AF was highest within the first year at 18%. Univariate analysis demonstrated that POAF was associated with significantly increased risk of late AF [hazard ratio (HR), 5.09; 95% CI, 3.65-7.22] and long-term mortality (HR, 1.79; 95% CI, 1.38-2.22). After adjustment for age, sex, and clinical and surgical risk factors, POAF remained independently associated with development of late AF (HR, 3.52; 95% CI, 2.42-5.13) but not long-term mortality (HR, 1.16; 95% CI, 0.87-1.55). Conversely, late AF was independently predictive of long-term mortality (HR, 3.25; 95% CI, 2.42-4.35). Diastolic dysfunction independently influenced the risk of late AF and long-term mortality.<br />Conclusions: Postoperative atrial fibrillation was an independent predictive marker of late AF, whereas late AF, but not POAF, was independently associated with long-term mortality. Patients who develop new-onset POAF should be considered for continuous anticoagulation at least during the first year following cardiac surgery.<br /> (Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Atrial Fibrillation etiology
Female
Follow-Up Studies
Humans
Incidence
Kaplan-Meier Estimate
Male
Middle Aged
Minnesota epidemiology
Prognosis
Retrospective Studies
Risk Factors
Survival Rate trends
Time Factors
Atrial Fibrillation epidemiology
Cardiac Surgical Procedures adverse effects
Population Surveillance
Postoperative Complications
Risk Assessment
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6744
- Volume :
- 170
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- American heart journal
- Publication Type :
- Academic Journal
- Accession number :
- 26386789
- Full Text :
- https://doi.org/10.1016/j.ahj.2015.06.015