Post-operative atrial fibrillation and long-term risk of stroke after isolated coronary artery bypass graft surgery

Umberto Benedetto, Mario F Gaudino, Arnaldo Dimagli, Stephen Gerry, Alastair Gray, Belinda Lees, Marcus Flather, David P Taggart

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Background: Post-operative atrial fibrillation (pAF) following coronary artery bypass grafting (CABG) 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 Arterial Revascularization Trial (ART).

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 prior history of atrial fibrillation (n=45), or had no information regarding 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 (SR). Competing risk and Cox regression analysis 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) vs 3.7% (2.9-4.5) in patients with pAF and SR respectively. pAF was an independent predictor of CVA at 10 years (HR 1.53; 95%CI 1.06-2.23; P-value=0.025) even when CVAs that occurred during the index admission were excluded from the analysis (HR 1.47; 95% 1.02-2.11; P=0.04).

Conclusions: Patients with pAF after CABG are at higher risk of CVA. These findings challenge the notion that pAF is a benign complication.
Original languageEnglish
Pages (from-to)1320-1329
Number of pages10
JournalJournal of the American Heart Association
Volume142
Issue number14
DOIs
Publication statusPublished - 5 Oct 2020

Structured keywords

  • Bristol Heart Institute

Keywords

  • post operative atrial fibrillation
  • stroke
  • coronary artery bypass graft surgery
  • cerebrovascular accidents

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