Postoperative Atrial Fibrillation and Long-Term Risk of Stroke After Isolated Coronary Artery Bypass Graft Surgery.
Postoperative Atrial Fibrillation and Long-Term Risk of Stroke After Isolated Coronary Artery Bypass Graft Surgery.
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DOI：
10.1161/circulationaha.120.046940
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发表时间：
2020-10-06
期刊：
影响因子：
37.8
通讯作者：
ART Investigators*
中科院分区：
文献类型：
--
作者：
Benedetto U;Gaudino MF;Dimagli A;Gerry S;Gray A;Lees B;Flather M;Taggart DP;ART Investigators*
冠状动脉旁路移植术（CABG）术后房颤（pAF）是一种常见的并发症。pAF是否与脑血管意外（CVA）风险增加相关仍不确定。我们通过对动脉血运重建试验（ART）的10年结果进行事后分析，研究了pAF与CVA长期风险之间的关系。在本分析中，在入组ART的患者（n=3102）中，我们排除了未接受手术（n=25）、既往有房颤病史（n=45）或无pAF发生率相关信息（n=9）的患者。最终人群包括3023例患者，其中734例（24.3%）发生pAF，其余2289例维持窦性心律（SR）。采用竞争风险和考克斯回归分析研究pAF与CVA风险之间的关系。10年时，pAF和SR患者的CVA累积发生率分别为6.3%（4.6-8.1）和3.7%（2.9-4.5）。pAF是10年时CVA的独立预测因素（HR 1.53; 95%CI 1.06-2.23; P值=0.025），即使将首次入院期间发生的CVA排除在分析之外（HR 1.47; 95%CI 1.02-2.11; P=0.04）。CABG术后pAF患者发生CVA的风险较高。这些发现挑战了pAF是良性并发症的观点。
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). 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. 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). Patients with pAF after CABG are at higher risk of CVA. These findings challenge the notion that pAF is a benign complication.