Long Term Outcome of Postoperative Atrial Fibrillation After Cardiac Surgery—A Propensity Score-Matched Cohort Analysis

Background: Postoperative atrial fibrillation (POAF) results in a longer hospital stay and excess mortality. However, whether POAF would increase stroke rate has been debated for years. When and how long should anticoagulation be used to prevent stroke are unknown. In the study, we planned to investigate the clinical demographics and long-term outcomes of POAF after cardiac surgery in a single-center cohort.Methods: The cohort study used a database from National Taiwan University Hospital, a single tertiary medical center in Taiwan, between 2007 and 2017, to identify patients with prior normal sinus rhythm developing POAF after cardiac surgery. Patients without POAF after cardiac surgery were used as controls. Propensity score matching with 1:1 ratio and Cox regression models were employed to estimate the risk of transient ischemic accident (TIA) or ischemic stroke.Results: From 2007 to 2017, a total of 8,374 patients received open-heart surgery, in which 1,585 patients with a history of AF were excluded. The overall incidence of TIA/ischemic stroke was 3.9% in a median 9.2-years of follow-up. After propensity matching, 1,965 matched paired subjects were included for analysis. Postoperative atrial fibrillation was associated with an increased risk of future AF [Hazard ratio (HR) 1.40, 95% confidence interval (95%CI) = 1.09–1.79, p = 0.008] and heart failure (HF) hospitalization (HR 1.58, 95%CI 1.23–2.04, p < 0.001); however, POAF did not significantly correlate with the risk of TIA/ischemic stroke (HR 1.17, 95%CI 0.85–1.60, p = 0.043). Kaplan-Meier analysis showed that POAF was a significant predictor for future AF, HF hospitalization, and overall mortality, but not for TIA/ischemic stroke.Conclusion: In the Asian population, POAF after cardiac surgery increased the risk of future AF, HF, and overall mortality, but was not associated with future TIA/ischemic stroke.

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Impact of the Total Number of Carotid Plaques on the Outcome of Ischemic Stroke Patients with Atrial Fibrillation

Journal of Clinical Medicine ◽

10.3390/jcm8111897 ◽

2019 ◽

Vol 8 (11) ◽

pp. 1897 ◽

Cited By ~ 1

Author(s):

Hyungjong Park ◽

Minho Han ◽

Young Dae Kim ◽

Joonsang Yoo ◽

Hye Sun Lee ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Intima Media Thickness ◽

Major Adverse Cardiovascular Events ◽

Stroke Patients ◽

Term Outcome ◽

Long Term Outcome ◽

Increased Risk ◽

Prognostic Utility

Background: Atrial fibrillation (AF) shares several risk factors with atherosclerosis. We investigated the association between total carotid plaque number (TPN) and long-term prognosis in ischemic stroke patients with AF. Methods: A total of 392 ischemic stroke patients with AF who underwent carotid ultrasonography were enrolled. TPN was assessed using B-mode ultrasound. The patients were categorized into two groups according to best cutoff values for TPN (TPN ≤ 4 vs. TPN ≥ 5). The long-term risk of major adverse cardiovascular events (MACE) and mortality according to TPN was investigated using a Cox hazard model. Results: After a mean follow-up of 2.42 years, 113 patients (28.8%) had developed MACE and 88 patients (22.4%) had died. MACE occurred more frequently in the TPN ≥ 5 group than in the TPN ≤ 4 group (adjusted hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.01–2.21; p < 0.05). Moreover, the TPN ≥ 5 group showed an increased risk of all-cause mortality (adjusted HR, 2.69; 95% CI, 1.40–5.17; p < 0.05). TPN along with maximal plaque thickness and intima media thickness showed improved prognostic utility when added to the variables of the CHAD2DS2-VASc score. Conclusion: TPN can predict the long-term outcome of ischemic stroke patients with AF. Adding TPN to the CHAD2DS2-VASc score increases the predictability of outcome after stroke.

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Compared with matched controls, patients with postoperative atrial fibrillation (POAF) have increased long-term AF after CABG, and POAF is further associated with increased ischemic stroke, heart failure and mortality even after adjustment for AF

Clinical Research in Cardiology ◽

10.1007/s00392-020-01614-z ◽

2020 ◽

Vol 109 (10) ◽

pp. 1232-1242 ◽

Cited By ~ 3

Author(s):

Emma Thorén ◽

Mona-Lisa Wernroth ◽

Christina Christersson ◽

Karl-Henrik Grinnemo ◽

Lena Jidéus ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Ischemic Stroke ◽

Observational Cohort Study ◽

Postoperative Atrial Fibrillation ◽

Observational Cohort ◽

Over Time ◽

Overall Mortality

Abstract Objective To analyze (1) associations between postoperative atrial fibrillation (POAF) after CABG and long-term cardiovascular outcome, (2) whether associations were influenced by AF during follow-up, and (3) if morbidities associated with POAF contribute to mortality. Methods An observational cohort study of 7145 in-hospital survivors after isolated CABG (1996–2012), with preoperative sinus rhythm and without AF history. Incidence of AF was compared with matched controls. Time-updated covariates were used to adjust for POAF-related morbidities during follow-up, including AF. Results Thirty-one percent of patients developed POAF. Median follow-up was 9.8 years. POAF patients had increased AF compared with matched controls (HR 3.03; 95% CI 2.66–3.49), while AF occurrence in non-POAF patients was similar to controls (1.00; 0.89–1.13). The observed AF increase among POAF patients compared with controls persisted over time (> 10 years 2.73; 2.13–3.51). Conversely, the non-POAF cohort showed no AF increase beyond the first postoperative year. Further, POAF was associated with long-term AF (adjusted HR 3.20; 95% CI 2.73–3.76), ischemic stroke (1.23; 1.06–1.42), heart failure (1.44; 1.27–1.63), overall mortality (1.21; 1.11–1.32), cardiac mortality (1.35; 1.18–1.54), and cerebrovascular mortality (1.54; 1.17–2.02). These associations remained after adjustment for AF during follow-up. Adjustment for other POAF-associated morbidities weakened the association between POAF and overall mortality, which became non-significant. Conclusions Patients with POAF after CABG had three times the incidence of long-term AF compared with both non-POAF patients and matched controls. POAF was associated with long-term ischemic stroke, heart failure, and corresponding mortality even after adjustment for AF during follow-up. The increased overall mortality was partly explained by morbidities associated with POAF. Graphic abstract

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2225“New-onset atrial fibrillation efter cardiac surgery is associated with increased long-term morbidity and mortality”: a population-based study from the SWEDEHEART-registry

European Heart Journal ◽

10.1093/eurheartj/ehz748.0121 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Taha ◽

A Jeppsson ◽

L Friberg ◽

S Nielsen ◽

A Ahlsson ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Population Based ◽

Long Term Outcome ◽

Increased Risk ◽

Cabg Patients ◽

Onset Atrial Fibrillation ◽

New Onset

Abstract Background New-onset postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery, but the prognostic implications are not settled. In contrast to previous reports, a recent Danish study in coronary bypass surgery (CABG) patients (Butt et al. JAMA Cardiol 2018) did not show any increased risk for thromboembolic complications in POAF patients. Purpose To compare long-term outcome in patients with vs. without POAF after CABG. Methods All CABG patients in Sweden 2005–2015 (n=38040) were included in a retrospective population-based cohort study. Data from the SWEDEHEART registry, the National Patient Registry and the National Population Registry were merged. POAF was defined as any new-onset atrial fibrillation (AF) episode up to the 30thpostoperative day. Inverse Probability Treatment Weighting (IPTW) adjusted Cox regression models were used to compare outcome variables after the first 30 postoperative days until the end of follow-up (median 5 years, range 0–10). The models were adjusted for age, gender, CHA2DS2-VASc score, co-morbidity, and medications. Results The mean age of the entire cohort was 68 years, 79% were men and 90% had a CHA2DS2-VASc score ≥2. The incidence of POAF was 28.5% (10845/38040). During follow-up POAF, patients had a significantly higher adjusted risk for all-cause mortality [Hazard Ratio (HR) 1.16 (95% CI 1.09–1.24)], ischemic stroke [HR 1.19 (1.09–1.30)], transient ischemic attack [HR 1.17 (1.03–1.33)], pulmonary embolism [HR 1.24 (1.01–1.54)], myocardial infarction [HR 1.14 (1.04–1.25)], heart failure hospitalizations [HR.1.46 (1.35–1.59)] and recurrent AF [HR 4.33 (4.09–4.65)]. Conclusions POAF was in this comparatively large study associated with increased risk for mortality and morbidity during long-term follow-up after CABG and is hence not a trivial complication.

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Epicardial Adipose Tissue and Postoperative Atrial Fibrillation

10.21203/rs.3.rs-588749/v1 ◽

2021 ◽

Author(s):

Petraglia Laura ◽

Conte Maddalena ◽

Comentale Giuseppe ◽

Cabaro Serena ◽

Campana Pasquale ◽

...

Keyword(s):

Atrial Fibrillation ◽

Adipose Tissue ◽

Cardiac Surgery ◽

Epicardial Adipose Tissue ◽

Perioperative Period ◽

Postoperative Atrial Fibrillation ◽

Serum Samples ◽

Monocyte Chemoattractant Protein 1 ◽

Elective Cardiac Surgery ◽

Increased Risk

Abstract Background. Atrial fibrillation (AF) often occurs after cardiac surgery and is associated to increased risk of stroke and mortality. Several evidence support the important role of inflammation in the pathogenesis of postoperative atrial fibrillation (POAF). It is known that an increased volume and a pro-inflammatory phenotype of epicardial adipose tissue (EAT) are both associated with AF onset in non surgical context. In the present study, we aim to evaluate whether also POAF occurrence may be triggered by an exalted production of inflammatory mediators from EAT.Methods. The study population was composed of 105 patients, with no history of paroxysmal or permanent AF, undergoing elective cardiac surgery. After clinical evaluation, all patients performed an echocardiographic study including the measurement of EAT thickness. Serum samples and EAT biopsies were collected before surgery. Levels of 10 inflammatory cytokines were measured in serum and EAT conditioned media. After surgery, cardiac rhythm was monitored for 7 days.Results. Forty-four patients (41.3%) developed POAF. As regard to cardiovascular therapy, only statin use was significantly lower in POAF patients (65.1% vs. 84.7%; p-0.032). Levels of Monocyte Chemoattractant Protein-1 (MCP-1), in both serum and EAT, were significantly higher in POAF patients (130.1 pg/ml vs. 68.7 pg/ml; p = < 0.001; 322.4 pg/ml vs. 153.4 pg/ml; p = 0.028 respectively). EAT levels of IL-6 were significantly increased in POAF patients compared to those in sinus rhythm (126.3 pg/ml vs. 23 pg/ml; p = < 0.005).ConclusionHigher EAT levels of IL6 and MCP1 are significantly associated with the occurrence of POAF. Statin therapy seems to play a role in preventing POAF. These results might pave the way for a targeted use of these drugs in the perioperative period.

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Abstract 4102: Preoperative Angiotensin Blocking Drug Therapy Does Not Reduce Atrial Fibrillation After Cardiac Surgery

Circulation ◽

10.1161/circ.118.suppl_18.s_829 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Florian Rader ◽

Eugene H Blackstone

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Drug Therapy ◽

Propensity Score ◽

Ace Inhibitors ◽

Postoperative Atrial Fibrillation ◽

Consecutive Series ◽

Blocking Drug ◽

Valvular Surgery ◽

Co Morbidity

Introduction: Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery. Angiotensin blocking drug therapy (ABDT) with Angiotensin converting enzyme (ACE) inhibitors and Angiotensin II receptor blockers (ARBs) has been shown to have anti-arrhythmic effects in animal models. However, data from small observational studies of ABDT use in patients undergoing cardiac surgery had discordant results and did not sufficiently adjust for selection bias. Therefore, we performed the largest study to date examining the association between preoperative use of ABDT and postoperative atrial fibrillation. Methods and Results: A consecutive series of 10,552 patients underwent coronary artery bypass graft (CABG) surgery with or without valvular surgery at Cleveland Clinic between 1997 through 2002. Of these 4,795 (45%) patients were on ABDT within 30 days prior to surgery and 3,633 (34%) patients developed POAF prior to discharge. Without adjusting for patient co-morbidities, ABDT had an Odds Ratio (OR) of 1.13 (95% Confidence Interval (CI) 1.05–1.25, p<0.01). A propensity score matched sample was developed, adjusting for 68 potential confounders. In the 6874 matched patients, who had a well balanced co-morbidity profile, ABDT was not associated with POAF (OR 1.03, CI 0.93–1.12, p=0.67). A subsequent propensity score matched analysis of 3227 patients, who underwent isolated valvular surgery in the same timeframe, also demonstrated ineffectiveness of preoperative ABDT (OR 0.91, CI 0.74 –1.09, p=0.33), irrespective of valve location. Stratified analysis by linear propensity score quintiles and propensity-adjusted logistic multivariable regression analysis of all patients in the CABG and the valvular surgery cohort confirmed these findings. Conclusions: In this large observational study preoperative use of ACE inhibitors or ARBs did not reduce postoperative occurrence of atrial fibrillation in patients undergoing cardiac surgery. Although withdrawal from ABDT prior to surgery is common practice and could account for this result, we cannot recommend such therapy for primary prophylaxis without larger randomized controlled trials.

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Antiplatelet therapy is not a safer alternative to oral anticoagulants, even in older hospital-discharged patients with atrial fibrillation

Geriatric Care ◽

10.4081/gc.2016.6120 ◽

2016 ◽

Vol 2 (2) ◽

Cited By ~ 1

Author(s):

Mario Bo ◽

Yolanda Falcone ◽

Enrica Grisoglio ◽

Margherita Marchetti ◽

Federica Li Puma ◽

...

Keyword(s):

Atrial Fibrillation ◽

Multivariate Analysis ◽

Ischemic Stroke ◽

Propensity Score ◽

Antiplatelet Therapy ◽

Oral Anticoagulant Therapy ◽

Bleeding Event ◽

Left Ventricular ◽

Cognitive Status ◽

Overall Mortality

Although oral anticoagulant therapy (OAT) is recommended for patients with atrial fibrillation (AF), it is widely underused among older patients, who are frequently prescribed antiplatelet therapy (APT) instead. We assessed mortality and incidence of ischemic and hemorrhagic events according to prescription of OAT or APT in older medical in-patients with AF discharged from hospital. Stroke and bleeding risk were evaluated using the CHA2DS2-VASC (Congestive heart failure/ left ventricular dysfunction, Hypertension, Aged ≥75 years, Diabetes Mellitus, Stroke/transient ischemic attack/systemic embolism, Vascular Disease, Aged 65-74 years, Sex Category) and HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly, Drugs/alcohol concomitantly) scores. Comorbidity, cognitive status and functional autonomy were assessed using standardized scales. Association of OAT and APT with overall mortality, ischemic stroke and bleeding events was evaluated through multivariate analysis and propensity score matching. During a mean follow-up period of 11 months 384 of the 962 patients discharged (mean age 82.9±6.6 years, 59.1% female) died (39.9%), 66 had an ischemic stroke and 49 experienced a major bleeding event. Compared with APT, OAT was associated with reduced overall mortality after multivariate analysis [odds ratio (OR) 0.62, confidence interval (CI): 0.46-0.83] and after propensity score matched analysis (OR 0.65, CI: 0.52-0.82, P=0.0004), with a not significant reduced incidence of total and fatal ischemic stroke, and without increase in total, intracranial, major and fatal bleedings. In a sample of older AF patients with poor health status, OAT was associated with reduced mortality, without evidence of a significant increase in major or fatal bleedings.

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Duration of Postoperative Atrial Fibrillation After Cardiac Surgery Is Associated With Worsened Long-Term Survival

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2016.05.016 ◽

2016 ◽

Vol 102 (6) ◽

pp. 2018-2026 ◽

Cited By ~ 12

Author(s):

Martin I. Sigurdsson ◽

Nicholas T. Longford ◽

Mahyar Heydarpour ◽

Louis Saddic ◽

Tzuu-Wang Chang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Postoperative Atrial Fibrillation ◽

Term Survival ◽

Long Term Survival

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Anticoagulation influences long-term outcome in patients with nonvalvular atrial fibrillation and severe ischemic stroke

The American Journal of Geriatric Pharmacotherapy ◽

10.1016/j.amjopharm.2004.12.001 ◽

2004 ◽

Vol 2 (4) ◽

pp. 265-273 ◽

Cited By ~ 4

Author(s):

Konstantinos N. Vemmos ◽

Georgios Tsivgoulis ◽

Konstantinos Spengos ◽

Efstathios Manios ◽

Savas Toumanidis ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Nonvalvular Atrial Fibrillation ◽

Term Outcome ◽

Long Term Outcome

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THE TYPE OF ATRIAL FIBRILLATION IS ASSOCIATED WITH LONG-TERM OUTCOME IN PATIENTS WITH ACUTE ISCHEMIC STROKE

European Journal of Internal Medicine ◽

10.1016/s0953-6205(11)60280-x ◽

2011 ◽

Vol 22 ◽

pp. S68-S69

Author(s):

George Ntaios ◽

Anastasia Vemmou ◽

Eleni Koromboki ◽

Paraskevi Savvari ◽

Michalis Saliaris ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Term Outcome ◽

Long Term Outcome

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Very Long-term Outcome after Linear vs. Electrogram-guided Ablation for Persistent Atrial Fibrillation: A Propensity Score-matched Analysis.

10.22541/au.161932382.26741762/v1 ◽

2021 ◽

Author(s):

Seigo Yamashita ◽

Michifumi Tokuda ◽

Saagar Mahida ◽

Hidenori Sato ◽

Hidetsugu Ikewaki ◽

...

Keyword(s):

Atrial Fibrillation ◽

Propensity Score ◽

Multivariable Analysis ◽

Persistent Atrial Fibrillation ◽

Logrank Test ◽

Term Outcome ◽

Long Term Outcome ◽

Free Survival ◽

Linear Ablation

Background: The optimal ablation strategy for persistent atrial fibrillation (PsAF) remains to be defined. We sought to compare very long-term outcomes between linear ablation and electrogram (EGM)-guided ablation for PsAF. Methods: In a retrospective analysis, long-term arrhythmia-free survival compared between two propensity-score matched cohorts, one with pulmonary vein isolation (PVI) and linear ablation including roof/mitral isthmus line (LINE-group, n=52) and one with PVI and EGM-guided ablation (EGM-group; n=52). Results: Overall, 99% of patients underwent successful PVI. Complete block following linear ablation was achieved for 94% of roof lines and 81% of mitral lines (both lines blocked in 75%). AF termination by EGM-guided ablation was accomplished in 40% of patients. Non-PV foci were targeted in 7 (13%) in the LINE-group and 5 (10%) patients in the EGM-group (p=0.76). During 100±28 months of follow-up, linear ablation was associated with superior arrhythmia-free survival after the initial and last procedure (1.8±0.9 procedures) compared with EGM-group (Logrank test: P=0.0001 and P=0.045, respectively). In multivariable analysis, longer AF duration and EGM-guided ablation remained as independent predictors of AAs recurrence. Conclusions: Linear ablation is a more effective complementary technique to PVI than EGM-guided ablation for PsAF ablation.

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