Differences in Postoperative Atrial Fibrillation Incidence and Outcomes After Cardiac Surgery According to Assessment Method and Definition: A Systematic Review and Meta-Analysis.
Differences in Postoperative Atrial Fibrillation Incidence and Outcomes After Cardiac Surgery According to Assessment Method and Definition: A Systematic Review and Meta-Analysis.
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DOI：
10.1161/jaha.123.030907
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发表时间：
2023-10-03
影响因子：
5.4
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中科院分区：
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术后心房颤动（POAF）是心脏手术最常见的并发症。尽管存在临床和经济影响，但各研究中POAF评估方法和定义存在很大差异。我们进行了一项研究水平的Meta分析，以评价POAF评估方法和定义对其发生率的影响及其与临床结局的相关性。进行了系统性文献检索，以识别比较心脏手术后有和无POAF患者结局的研究，这些研究也报告了POAF评估方法。主要结局为POAF发生率。次要结局为院内死亡率、卒中、重症监护室住院时间和术后住院时间。纳入了59项研究，共计197774例患者。POAF累积发生率为26%（范围：7.3%-53.1%）。不同评估方法的POAF发生率无差异（连续遥测为27%[范围：7.3%-53.1%]，遥测加每日ECG为27% [范围：7.9%-50%]，仅每日ECG为19% [范围：7.8%-42.4%];所有比较P>0.05）。两种评估方法在住院死亡率、卒中、重症监护室住院时间和术后住院时间方面无差异。POAF定义之间POAF发生率或任何其他结局无差异。在仅包括接受隔离冠状动脉旁路移植术患者的研究中，与每日ECG相比，连续遥测和遥测加每日ECG与更高的POAF发生率相关。心脏手术后POAF的发病率仍然很高，并且不同研究的检出率不同。POAF发生率及其与不良结局的相关性不受所用评估方法和定义的影响，接受隔离冠状动脉旁路移植术的患者除外。
Postoperative atrial fibrillation (POAF) is the most frequent complication of cardiac surgery. Despite clinical and economic implications, ample variability in POAF assessment method and definition exist across studies. We performed a study‐level meta‐analysis to evaluate the influence of POAF assessment method and definition on its incidence and association with clinical outcomes. A systematic literature search was conducted to identify studies comparing the outcomes of patients with and without POAF after cardiac surgery that also reported POAF assessment method. The primary outcome was POAF incidence. The secondary outcomes were in‐hospital mortality, stroke, intensive care unit length of stay, and postoperative length of stay. Fifty‐nine studies totaling 197 774 patients were included. POAF cumulative incidence was 26% (range: 7.3%–53.1%). There were no differences in POAF incidence among assessment methods (27%, [range: 7.3%–53.1%] for continuous telemetry, 27% [range: 7.9%–50%] for telemetry plus daily ECG, and 19% [range: 7.8%–42.4%] for daily ECG only; P>0.05 for all comparisons). No differences in in‐hospital mortality, stroke, intensive care unit length of stay, and postoperative length of stay were found between assessment methods. No differences in POAF incidence or any other outcomes were found between POAF definitions. Continuous telemetry and telemetry plus daily ECG were associated with higher POAF incidence compared with daily ECG in studies including only patients undergoing isolated coronary artery bypass grafting. POAF incidence after cardiac surgery remains high, and detection rates are variable among studies. POAF incidence and its association with adverse outcomes are not influenced by the assessment method and definition used, except in patients undergoing isolated coronary artery bypass grafting.