New-Onset Atrial Fibrillation After Coronary Artery Bypass Grafting and Long-Term Outcome: A Population-Based Nationwide Study From the SWEDEHEART Registry.
New-Onset Atrial Fibrillation After Coronary Artery Bypass Grafting and Long-Term Outcome: A Population-Based Nationwide Study From the SWEDEHEART Registry.
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DOI：
10.1161/jaha.120.017966
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发表时间：
2021-01-05
影响因子：
5.4
通讯作者：
Jeppsson A
中科院分区：
文献类型：
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作者：
Taha A;Nielsen SJ;Bergfeldt L;Ahlsson A;Friberg L;Björck S;Franzén S;Jeppsson A
冠状动脉旁路移植术后新发房颤（POAF）的长期影响和早期口服抗凝（OAC）对POAF患者的益处尚不确定。从2007年到2015年，所有在瑞典接受冠状动脉旁路移植术且术前无房颤的患者被纳入一项基于人群的研究，该研究使用了来自4个国家登记处的数据：SWEDEHEART（瑞典根据推荐疗法评估心脏病循证护理的增强和发展网络系统）、国家患者登记处、配药登记处和死因登记处。POAF定义为术后30天内任何新发心房颤动。Cox回归模型（调整年龄、性别、合并症和药物）用于评估有或无POAF患者的长期预后，以及早期OAC与预后之间的潜在关联。在24523例冠状动脉搭桥术患者队列中，7368例（30.0%）患者发生POAF，其中1770例（24.0%）患者在术后30天内开了OAC。在随访期间（中位4.5年，范围0-9年），POAF与缺血性卒中（校正危险比[aHR] 1.18 [95% CI, 1.05-1.32]）、任何血栓栓塞（缺血性卒中、短暂性脑缺血发作或外周动脉栓塞）（aHR 1.16, 1.05-1.28）、心力衰竭住院（aHR 1.35, 1.21-1.51）和复发性房颤（aHR 4.16, 3.76-4.60）的风险增加相关，但与全因死亡率无关（aHR 1.08, 0.98-1.18）。早期开始OAC与缺血性卒中或任何血栓栓塞的风险降低无关，但与大出血的风险增加相关（aHR 1.40, 1.08-1.82）。冠状动脉旁路移植术后POAF与不良预后影响相关。早期OAC治疗的作用尚不清楚。旨在减少POAF发生及其后果的研究是必要的。
The long‐term impact of new‐onset postoperative atrial fibrillation (POAF) after coronary artery bypass grafting and the benefit of early‐initiated oral anticoagulation (OAC) in patients with POAF are uncertain. All patients who underwent coronary artery bypass grafting without preoperative atrial fibrillation in Sweden from 2007 to 2015 were included in a population‐based study using data from 4 national registries: SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence‐based Care in Heart Disease Evaluated According to Recommended Therapies), National Patient Registry, Dispensed Drug Registry, and Cause of Death Registry. POAF was defined as any new‐onset atrial fibrillation during the first 30 postoperative days. Cox regression models (adjusted for age, sex, comorbidity, and medication) were used to assess long‐term outcome in patients with and without POAF, and potential associations between early‐initiated OAC and outcome. In a cohort of 24 523 patients with coronary artery bypass grafting, POAF occurred in 7368 patients (30.0%), and 1770 (24.0%) of them were prescribed OAC within 30 days after surgery. During follow‐up (median 4.5 years, range 0‒9 years), POAF was associated with increased risk of ischemic stroke (adjusted hazard ratio [aHR] 1.18 [95% CI, 1.05‒1.32]), any thromboembolism (ischemic stroke, transient ischemic attack, or peripheral arterial embolism) (aHR 1.16, 1.05‒1.28), heart failure hospitalization (aHR 1.35, 1.21‒1.51), and recurrent atrial fibrillation (aHR 4.16, 3.76‒4.60), but not with all‐cause mortality (aHR 1.08, 0.98‒1.18). Early initiation of OAC was not associated with reduced risk of ischemic stroke or any thromboembolism but with increased risk for major bleeding (aHR 1.40, 1.08‒1.82). POAF after coronary artery bypass grafting is associated with negative prognostic impact. The role of early OAC therapy remains unclear. Studies aiming at reducing the occurrence of POAF and its consequences are warranted.