The persistent problem of new-onset postoperative atrial fibrillation: a single-institution experience over two decades.
The persistent problem of new-onset postoperative atrial fibrillation: a single-institution experience over two decades.
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DOI：
10.1016/j.jtcvs.2010.03.011
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发表时间：
2011-02
影响因子：
6
通讯作者：
Schuessler, Richard B.
中科院分区：
文献类型：
--
作者：
Shen, Jeanne;Lall, Shelly;Zheng, Victoria;Buckley, Patricia;Damiano, Ralph J., Jr.;Schuessler, Richard B.
术后心房颤动（POAF）是心脏手术后最常见的并发症。各种POAF危险因素已被报道，但研究结果不一致或相互矛盾，特别是在既往存在心房颤动的患者中。在10390例心脏手术患者中评估了POAF的发生率，其中包括各种危险因素，以确定POAF的可靠预测因素。这项20年的回顾性研究调查了POAF与人口因素、术前健康状况和药物、手术程序和术后并发症之间的关系。采用多变量logistic回归模型评估POAF的潜在预测因素。年龄增加、二尖瓣手术（OR=1.91）、左室动脉瘤修复（OR=1.57）、主动脉瓣手术（OR=1.52）、种族（高加索人种）（OR=1.51）、使用心脏截瘫（OR=1.36）、使用主动脉内球囊泵（OR=1.28）、既往充血性心力衰竭（OR=1.28）和高血压（OR=1.15）与POAF显著相关。年龄与POAF之间的非线性关系揭示了55岁及以上患者POAF风险的加速。在接受冠状动脉旁路移植术的患者中，年龄增加和既往充血性心力衰竭是唯一与POAF高风险相关的因素。POAF的发病率没有随时间变化的趋势。没有检测到针对POAF的保护因素，包括常用的处方药物类别。POAF问题的持续存在，以及使用常见风险因素的适度可预测性，表明在了解其病因和治疗方面取得的进展有限。
Postoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery. A variety of POAF risk factors has been reported, but study results have been inconsistent or contradictory, particularly in patients with preexisting atrial fibrillation. The incidence of POAF was evaluated in a group of 10,390 cardiac surgery patients among a comprehensive range of risk factors to identify reliable predictors of POAF. This 20-year retrospective study examined the relationship between POAF and demographic factors, preoperative health conditions and medications, operative procedures, and postoperative complications. Multivariate logistic regression models were used to evaluate potential predictors of POAF. Increasing age, mitral valve surgery (OR=1.91), left ventricular aneurysm repair (OR=1.57), aortic valve surgery (OR=1.52), race (Caucasian) (OR=1.51), use of cardioplegia (OR=1.36), use of an intra-aortic balloon pump (OR=1.28), previous congestive heart failure (OR=1.28), and hypertension (OR=1.15) were significantly associated with POAF. The nonlinear relationship between age and POAF revealed the acceleration of POAF risk in patients 55 or older. In patients undergoing coronary artery bypass grafting, increasing age and previous congestive heart failure were the only factors associated with a higher risk of POAF. There was no trend in incidence of POAF over time. No protective factors against POAF were detected, including commonly prescribed categories of medications. The persistence of the problem of POAF, and the modest predictability using common risk factors, suggest that limited progress has been made in understanding its etiology and treatment.
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