A time-related parametric risk factor analysis for postoperative atrial fibrillation after heart surgery
A time-related parametric risk factor analysis for postoperative atrial fibrillation after heart surgery
复制标题
DOI：
10.1016/j.jtcvs.2014.11.032
复制
发表时间：
2015-03-01
影响因子：
6
通讯作者：
Kirklin, James K.
中科院分区：
文献类型：
--
作者：
Melby, Spencer J.;George, James F.;Kirklin, James K.
目的：术后心房颤动可能涉及多种机制。因此，我们的目的是确定术后房颤的危险因素作为冠状动脉旁路移植术或瓣膜手术后时间的函数，以确定哪些危险因素可能在不同时间占主导地位。方法：确定了1583例患者的参数风险函数，（单独冠状动脉旁路移植术、二尖瓣手术和主动脉瓣置换+/-冠状动脉旁路移植术）。进行多变量危险因素分析，术后房颤的风险进行了估计。结果：所有患者术后房颤的风险是最高的术后立即和48小时。初始峰值风险在术后18小时内下降至约为零。第二个峰值出现在48小时，随后在接下来的4至7天内缓慢下降。包含这些峰值的时间间隔被称为I相和II相。I期的主要危险因素是年龄较大（相对危险度[RR]，1.6; P = 0.006）、交叉夹闭时间较长（RR，1.3; P = 0.001）和二尖瓣手术（RR，2.5; P = 0.0001）。在第二阶段，这些因素是年龄较大（RR，3.0; P <0.0001），体重较大（RR，1.6; P <0.0001）和白人种族（RR，2.5; P = 0.006）。二尖瓣置换术患者术后Ⅱ期房颤的风险高于单纯冠状动脉旁路移植术患者，术后9 d仍高于单纯冠状动脉旁路移植术患者，术后6 d房颤风险恢复至基线水平。结论：Ⅰ期和Ⅱ期患者有不同的风险因素;因此，术后心房颤动的机制可能会随着时间的推移而改变。
Objectives: Multiple mechanisms may be involved in postoperative atrial fibrillation. Therefore, our objective was to determine the risk factors for postoperative atrial fibrillation as a function of time after coronary artery bypass grafting or valve surgeries to determine which risk factors might predominate at different times.Methods: Parametric hazard functions were determined for 1583 patients and then in subgroups (coronary artery bypass grafting alone, mitral valve procedure, and aortic valve replacement +/- coronary artery bypass grafting). Multivariable risk factor analyses were performed, and the risk for postoperative atrial fibrillation was estimated.Results: The risk for postoperative atrial fibrillation for all patients was highest immediately postoperatively and at 48 hours. The initial peak risk declined to approximately zero within 18 hours postoperatively. A second peak occurred at 48 hours, followed by a slow decline over the following 4 to 7 days. The time intervals encompassing these peaks were termed phase I and phase II. Predominant risk factors in phase I were older age (relative risk [RR], 1.6; P = .006), longer crossclamp time (RR, 1.3; P = .001), and mitral valve procedure (RR, 2.5; P = .0001). In phase II, these were older age (RR, 3.0; P < .0001), greater weight (RR, 1.6; P < .0001), and Caucasian race (RR, 2.5; P = .006). For patients receiving a mitral valve procedure, the risk for postoperative atrial fibrillation in phase II was higher and remained elevated for as long as 9 days postoperatively in comparison with isolated coronary artery bypass grafting, for which the risk returned to near baseline by postoperative day 6.Conclusions: Phase I and phase II periods are associated with distinct risk factors; therefore, it is likely that the mechanisms of postoperative atrial fibrillation change over time.