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J Am Coll Cardiol, 2004; 43:742-748, doi:10.1016/j.jacc.2003.11.023
© 2004 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: COMPLICATIONS OF BYPASS SURGERY

Postoperative atrial fibrillation and mortality after coronary artery bypass surgery

Rollo P. Villareal, MD*,*, Ramesh Hariharan, MD{dagger}{ddagger}, Brant C. Liu, MD{dagger}{ddagger}, Biswajit Kar, MD{dagger}, Vei-Vei Lee, MS§, MacArthur Elayda, MD, PhD§, J. Alberto Lopez, MD{dagger}{ddagger}, Abdi Rasekh, MD{dagger}{ddagger}, James M. Wilson, MD{dagger} and Ali Massumi, MD{dagger}{ddagger}

* Sections of Cardiology and Cardiac Electrophysiology, Self Regional Healthcare, Greenwood, South Carolina, USA
{dagger} Cardiology, Houston, Texas, USA
{ddagger} Cardiac Electrophysiology, Houston, Texas, USA
§ Biostatistics and Epidemiology, St. Luke's Episcopal Hospital/Texas Heart Institute, Houston, Texas., USA

Manuscript received June 25, 2002; revised manuscript received October 25, 2002, accepted November 13, 2003.

* Reprint requests and correspondence: Dr. Rollo P. Villareal, 1132 Spring Street, Greenwood, South Carolina 29646, USA.
rollovillareal{at}yahoo.com

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.

Abbreviations and Acronyms
  AF = atrial fibrillation
  CABG = coronary artery bypass graft surgery
  CAD = coronary artery disease
  CHF = congestive heart failure
  CI = confidence intervals
  COPD = chronic obstructive pulmonary disease
  CPK = creatine phosphokinase
  CVD = cerebrovascular disease
  IMA = internal mammary artery
  LOS = length of stay
  MI = myocardial infarction
  OR = odds ratio
  PVD = peripheral vascular disease
  THI = Texas Heart Institute
  TIA = transient ischemic attack




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