Long-Term Survival in Patients with Post-Operative Atrial Fibrillation after Cardiac Surgery: Analysis from a Prospective Cohort Study
Background: Post-operative (POP) atrial fibrillation (AF) is frequent in patients who undergo cardiac surgery. However, its prognostic impact in the long term remains unclear. Methods: We followed 1386 patients who underwent cardiac surgery for an average of 10 ± 3 years. According to clinical histo...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-12-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/8/12/169 |
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| author | Jacopo Marazzato Sergio Masnaghetti Roberto De Ponti Paolo Verdecchia Federico Blasi Sandro Ferrarese Monica Trapasso Antonio Spanevello Fabio Angeli |
| author_facet | Jacopo Marazzato Sergio Masnaghetti Roberto De Ponti Paolo Verdecchia Federico Blasi Sandro Ferrarese Monica Trapasso Antonio Spanevello Fabio Angeli |
| author_sort | Jacopo Marazzato |
| collection | DOAJ |
| description | Background: Post-operative (POP) atrial fibrillation (AF) is frequent in patients who undergo cardiac surgery. However, its prognostic impact in the long term remains unclear. Methods: We followed 1386 patients who underwent cardiac surgery for an average of 10 ± 3 years. According to clinical history of AF before and after surgery, four subgroups were identified: (1) patients with no history of AF and without episodes of AF during the first 30 days after surgery (control or Group 1, n = 726), (2) patients with no history of AF before surgery in whom new-onset POP AF was detected during the first 30 days after surgery (new-onset POP AF or Group 2, n = 452), (3) patients with a history of paroxysmal/persistent AF before cardiac surgery (Group 3, n = 125, including 87 POP AF patients and 38 who did not develop POP AF), and (4) patients with permanent AF at the time of cardiac surgery (Group 4, n = 83). All-cause mortality was the primary outcome of the study. We tested the associations of potential determinants with all-cause mortality using univariable and multivariable statistical analyses. Results: Overall, 473 patients (34%) died during follow-up. After adjustment for multiple confounders, new-onset POP AF (hazard ratio (HR) = 1.31, 95% confidence interval (CI): 0.90–1.89; <i>p</i> = 0.1609), history of paroxysmal/persistent AF before cardiac surgery (HR = 1.33, 95% CI: 0.71–2.49; <i>p</i> = 0.3736), and permanent AF (Group 4) (HR = 1.55, 95% CI 0.82–2.95; <i>p</i> = 0.1803) were not associated with a significantly increased risk of mortality when compared with Group 1 (patients with no history of AF and without episodes of AF during the first 30 days after surgery). In new-onset POP AF patients, oral anticoagulation was not associated with mortality (HR = 1.13, 95% CI: 0.83–1.54; <i>p</i> = 0.4299). Conclusions: In this cohort of patients who underwent different types of heart surgery, POP AF was not associated with an increased risk of mortality. In this setting, the role of long-term anticoagulation remains unclear. |
| first_indexed | 2024-03-10T03:51:34Z |
| format | Article |
| id | doaj.art-467b3b24618d463f857a47ce32d4d80c |
| institution | Directory Open Access Journal |
| issn | 2308-3425 |
| language | English |
| last_indexed | 2024-03-10T03:51:34Z |
| publishDate | 2021-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj.art-467b3b24618d463f857a47ce32d4d80c2023-11-23T08:54:52ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252021-12-0181216910.3390/jcdd8120169Long-Term Survival in Patients with Post-Operative Atrial Fibrillation after Cardiac Surgery: Analysis from a Prospective Cohort StudyJacopo Marazzato0Sergio Masnaghetti1Roberto De Ponti2Paolo Verdecchia3Federico Blasi4Sandro Ferrarese5Monica Trapasso6Antonio Spanevello7Fabio Angeli8Department of Medicine and Surgery, University of Insubria, 21100 Varese, ItalyDepartment of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS, 21049 Tradate, ItalyDepartment of Medicine and Surgery, University of Insubria, 21100 Varese, ItalyFondazione Umbra Cuore e Ipertensione-ONLUS and Division of Cardiology, Hospital Santa Maria della Misericordia, 06100 Perugia, ItalyDepartment of Medicine and Surgery, University of Insubria, 21100 Varese, ItalyDepartment of Medicine and Surgery, University of Insubria, 21100 Varese, ItalyDipartimento di Igiene e Prevenzione Sanitaria, PSAL, Sede Territoriale di Varese, ATS Insubria, 21100 Varese, ItalyDepartment of Medicine and Surgery, University of Insubria, 21100 Varese, ItalyDepartment of Medicine and Surgery, University of Insubria, 21100 Varese, ItalyBackground: Post-operative (POP) atrial fibrillation (AF) is frequent in patients who undergo cardiac surgery. However, its prognostic impact in the long term remains unclear. Methods: We followed 1386 patients who underwent cardiac surgery for an average of 10 ± 3 years. According to clinical history of AF before and after surgery, four subgroups were identified: (1) patients with no history of AF and without episodes of AF during the first 30 days after surgery (control or Group 1, n = 726), (2) patients with no history of AF before surgery in whom new-onset POP AF was detected during the first 30 days after surgery (new-onset POP AF or Group 2, n = 452), (3) patients with a history of paroxysmal/persistent AF before cardiac surgery (Group 3, n = 125, including 87 POP AF patients and 38 who did not develop POP AF), and (4) patients with permanent AF at the time of cardiac surgery (Group 4, n = 83). All-cause mortality was the primary outcome of the study. We tested the associations of potential determinants with all-cause mortality using univariable and multivariable statistical analyses. Results: Overall, 473 patients (34%) died during follow-up. After adjustment for multiple confounders, new-onset POP AF (hazard ratio (HR) = 1.31, 95% confidence interval (CI): 0.90–1.89; <i>p</i> = 0.1609), history of paroxysmal/persistent AF before cardiac surgery (HR = 1.33, 95% CI: 0.71–2.49; <i>p</i> = 0.3736), and permanent AF (Group 4) (HR = 1.55, 95% CI 0.82–2.95; <i>p</i> = 0.1803) were not associated with a significantly increased risk of mortality when compared with Group 1 (patients with no history of AF and without episodes of AF during the first 30 days after surgery). In new-onset POP AF patients, oral anticoagulation was not associated with mortality (HR = 1.13, 95% CI: 0.83–1.54; <i>p</i> = 0.4299). Conclusions: In this cohort of patients who underwent different types of heart surgery, POP AF was not associated with an increased risk of mortality. In this setting, the role of long-term anticoagulation remains unclear.https://www.mdpi.com/2308-3425/8/12/169atrial fibrillationpost-operative atrial fibrillationcardiac surgeryoral anticoagulationchronic disease |
| spellingShingle | Jacopo Marazzato Sergio Masnaghetti Roberto De Ponti Paolo Verdecchia Federico Blasi Sandro Ferrarese Monica Trapasso Antonio Spanevello Fabio Angeli Long-Term Survival in Patients with Post-Operative Atrial Fibrillation after Cardiac Surgery: Analysis from a Prospective Cohort Study Journal of Cardiovascular Development and Disease atrial fibrillation post-operative atrial fibrillation cardiac surgery oral anticoagulation chronic disease |
| title | Long-Term Survival in Patients with Post-Operative Atrial Fibrillation after Cardiac Surgery: Analysis from a Prospective Cohort Study |
| title_full | Long-Term Survival in Patients with Post-Operative Atrial Fibrillation after Cardiac Surgery: Analysis from a Prospective Cohort Study |
| title_fullStr | Long-Term Survival in Patients with Post-Operative Atrial Fibrillation after Cardiac Surgery: Analysis from a Prospective Cohort Study |
| title_full_unstemmed | Long-Term Survival in Patients with Post-Operative Atrial Fibrillation after Cardiac Surgery: Analysis from a Prospective Cohort Study |
| title_short | Long-Term Survival in Patients with Post-Operative Atrial Fibrillation after Cardiac Surgery: Analysis from a Prospective Cohort Study |
| title_sort | long term survival in patients with post operative atrial fibrillation after cardiac surgery analysis from a prospective cohort study |
| topic | atrial fibrillation post-operative atrial fibrillation cardiac surgery oral anticoagulation chronic disease |
| url | https://www.mdpi.com/2308-3425/8/12/169 |
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