Postoperative Atrial Fibrillation and Long-Term Risk of Stroke After Isolated Coronary Artery Bypass Graft Surgery
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Published:2020-10-06
Issue:14
Volume:142
Page:1320-1329
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ISSN:0009-7322
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Container-title:Circulation
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language:en
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Short-container-title:Circulation
Author:
Benedetto Umberto1ORCID, Gaudino Mario F.2, Dimagli Arnaldo1ORCID, Gerry Stephen3, Gray Alastair4, Lees Belinda5, Flather Marcus6, Taggart David P.5, Westaby S., Cook J., Wallis C., Wos S., Jasinski M., Widenka K., Blach A., Gocol R., Hudziak D., Zurek P., Deja M., Bachowski R., Mrozek R., Kargul T., Domarardzki W., Frackiewicz J., Zamvar V., Ezakadan D., Buxton B., Seevanayagam S., Matalanis G., Rosalion A., Negri J., Moten S., Atkinson V., Newcomb A., Polidano P., Pana R., Gerbo S., O’Keefe P., von Oppell U., Mehta D., Azzu A., Szafranek A., Kulatilake E., Evans J., Martin N., Banner D., Trivedi U., Forsyth A., Hyde J., Cohen A., Lewis M., Gardner E., MacKenzie A., Cooter N., Joyce E., Parker J., Champney F., Clark S., Dark J., Tocewicz K., Pillay T., Rowling S., Adams-Hall J., Bochenek A., Cisowski M., Bolkowski M., Morawski W., Guc M., Krejca M., Wilczynski M., Duralek A., Gerber W., Skarysz J., Shrestha R., Swiech W., Szmagala P., Krzych L., Pawlak A., Kepa K., Hasan R., Keenan D., Prendergast B., Odom N., McLaughlin K., Cummings-Fosong G., Mathew C., Iles-Smith H., Oomen A., Desai J., El-Gamel A., John L., Wendler O., Andrews M., Rance K., Williams R., Hogervorst V., Gregory J., Jessup J., Knighton A., Hoare A., Ritchie A., Choong C., Nair S., Jenkins D., Large S., Sudarshan C., Barman M., Dhital K., Routledge T., Rosengard B., Munday H., Rintoul K., Jarrett E., Lao-Sirieix S., Wilkinson A., Garner L., Osmond J., Holcombe H., Cale A., Griffin S., Dickson J., Cook J., Spyt T., Hickey M., Sosnowski A., Peek G., Szostek J., Hadjinikalaou L., Logtens E., Oakley M., Leji S., Gaer J., Amrani M., Dreyfus G., Bahrami T., Baig K., Asimakopoulos G., Vohra H., Pai V., Tadjkarimi, Soleimani S., Stavri G., Bull G., Collappen H., Sadowksi J., Gaweda B., Rudzinski P., Stolinski J., Konstanty-Kalandyk J., Moraes F., Moraes C., Wanderley J., Pepper J., De Souza A., Petrou M., Trimlett R., Morgan T., Gavino J., Wang S.F., Chandrasekaran V., Kanagasaby R., Sarsam M., Ryan H., Billings L., Ruddick L., Achampong A., Forster E., Pawlaczyk R., Siondalski P., Rogowski J., Roszak K., Jarmoszewicz K., Jagielak D., Gafka S., Mannam, Naguboyin G., Rao Sajja L., Dandu B., Briffa N., Braidley P., Cooper G., Knighton A., Allen K., Sangha G., Bridge C., McMellon H., Casabona R., Actis Dato G., Bardi G., Del Ponte, Forsennati S., Parisi F., Punta G., Flocco R., Sansone F., Zingarelli E., Dihmis W., Kuduvali M., Rince C., Rogers H., McQuade L., Anisimowicz L., Bokszanski M., Pawliszak W., Kolakowski J., Lau G., Ogorzeja W., Gumanska I., Kulinski P., Podesser B., Trescher K., Bernecker O., Holzinger C., Binder K., Schor I., Bergmann P., Kassal H., Motovova B., Trehan N., Meharwal Z., Malhotra R., Goel M., Kumer B., Bazaz S., Bake N., Singh A., Mishka Y., Gupta R., Basumatary S., Zembala M., Szafron B., Pacholewicz J., Krason M., Widenka K., Szymanik I., Kolwca M., Mazur W., Kurowicki A., Zurek S., Stacel T., Jaworska I.
Affiliation:
1. Bristol Heart Institute, School of Clinical Sciences, University of Bristol, United Kingdom (U.B., A.D.). 2. Weill Cornell Medicine, New York–Presbyterian Hospital, New York (M.F.G.). 3. Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (S.G.), University of Oxford, United Kingdom. 4. Health Economics Research Centre, Nuffield Department of Population Health (A.G.), University of Oxford, United Kingdom. 5. Nuffield Department of Surgical Sciences, John Radcliffe Hospital (B.L., D.P.T.), University of Oxford, United Kingdom. 6. Research and Development Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom (M.F.).
Abstract
Background:
Postoperative atrial fibrillation (pAF) after coronary artery bypass grafting 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 ART (Arterial Revascularization Trial).
Methods:
For the present analysis, among patients enrolled in the ART (n=3102), we excluded those who did not undergo surgery (n=25), had a history of atrial fibrillation (n=45), or had no information on 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. Competing risk and Cox regression analyses were used to investigate the association between pAF and the risk of CVA.
Results:
At 10 years, the cumulative incidence of CVA was 6.3% (4.6%–8.1%) versus 3.7% (2.9%–4.5%) in patients with pAF and sinus rhythm, respectively. pAF was an independent predictor of CVA at 10 years (hazard ratio, 1.53 [95% CI, 1.06–2.23];
P
=0.025) even when CVAs that occurred during the index admission were excluded from the analysis (hazard ratio, 1.47 [95% 1.02–2.11];
P
=0.04).
Conclusions:
Patients with pAF after coronary artery bypass grafting are at higher risk of CVA. These findings challenge the notion that pAF is a benign complication.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Physiology (medical),Cardiology and Cardiovascular Medicine
Cited by
69 articles.
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