Postoperative atrial fibrillation and mortality after coronary artery bypass surgery
Postoperative atrial fibrillation and mortality after coronary artery bypass surgery
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DOI：
10.1016/j.jacc.2003.11.023
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发表时间：
2004-03-03
影响因子：
24
通讯作者：
Massumi, A
中科院分区：
文献类型：
--
作者：
Villareal, RP;Hariharan, R;Massumi, A
我们试图确定术后心房颤动（AF）的发生是否影响冠状动脉旁路手术（CABG）后的早期或晚期死亡率。背景心房颤动是CABG后最常见的心律失常。方法使用德克萨斯心脏研究所心血管研究数据库识别1993年1月至1999年12月期间所有在孤立性初始CABG后发生AF的患者（n = 10）。994）。将该人群与同期接受CABG但未发生AF的患者（n = 5，481）进行比较。使用逻辑回归模型调整院内终点，以解释基线差异。长期生存率采用回顾性队列设计进行评估，其中考克斯比例风险方法用于调整基线差异，并与病例匹配的人群（n = 390，每组195）。术后AF与更高的住院死亡率（比值比[OR] 1.7，p = 0.0001）、更多的卒中（OR 2.02，p = 0.001）、更长的住院时间（14 vs. 10天，p < 0.0001）和更低的心肌梗死发生率（OR 0.62，p = 0.01）相关。在4 - 5年时，发生术后AF的患者的生存率更差（回顾性队列中为74% vs. 87%，p < 0.0001;病例匹配人群中为80% vs. 93%，p = 0.003）。在多变量分析中，术后AF是长期死亡率的独立预测因子（回顾性队列中调整OR 1.5，p < 0.001;病例匹配人群中OR 3.4，p = 0.0018）。各种策略，如抗心律失常药和华法林，旨在减少AF及其并发症的影响值得进一步研究。(C)2004年，美国心脏病学会基金会。
OBJECTIVES We sought to determine if the occurrence of postoperative atrial fibrillation (AF) affects early or late mortality following coronary artery bypass surgery (CABG).BACKGROUND Atrial fibrillation is the most common arrhythmia seen following CABG.METHODS The Texas Heart Institute Cardiovascular Research Database was used to identify all patients that developed AF after isolated initial CABG from January 1993 to December 1999 (n = 994). This population was compared with patients who underwent CABG during the same period but did not develop AF (n = 5,481). In-hospital end points were adjusted using logistic regression models to account for baseline differences. Long-term survival was evaluated using a retrospective cohort design, where Cox proportional hazards methods were used to adjust for baseline differences, and with case-matched populations (n = 390, 195 per arm).RESULTS Atrial fibrillation was diagnosed in 16% of the population. Postoperative AF was associated with greater in-hospital mortality (odds ratio [OR] 1.7, p = 0.0001), more strokes (OR 2.02, p = 0.001), prolonged hospital stays (14 vs. 10 days, p < 0.0001), and a reduced incidence of myocardial infarction (OR 0.62, p = 0.01). At four to five years, survival was worse in patients who developed postoperative AF (74% vs. 87%, p < 0.0001 in the retrospective cohort; 80% vs. 93%, p = 0.003 in the case-matched population). On multivariate analysis, postoperative AF was an independent predictor of long-term mortality (adjusted OR 1.5, p < 0.001 in the retrospective cohort; OR 3.4, p = 0.0018 in the case-matched population).CONCLUSIONS The occurrence of AF following CABG identifies a subset of patients who have a reduced survival probability following CABG. The impact of various strategies, such as antiarrhythmics and warfarin, aimed at reducing AF and its complications deserves further study. (C) 2004 by the American College of Cardiology Foundation.