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.
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 language | English |
|---|---|
| Pages (from-to) | 1320-1329 |
| Number of pages | 10 |
| Journal | Journal of the American Heart Association |
| Volume | 142 |
| Issue number | 14 |
| DOIs | |
| Publication status | Published - 5 Oct 2020 |
Structured keywords
- Bristol Heart Institute
Keywords
- post operative atrial fibrillation
- stroke
- coronary artery bypass graft surgery
- cerebrovascular accidents