New‐Onset Perioperative Atrial Fibrillation After Coronary Artery Bypass Grafting and Long‐Term Risk of Adverse Events: An Analysis From the CORONARY Trial
Background Perioperative atrial fibrillation (POAF) is common in patients undergoing cardiac surgery. Conflicting evidence exists whether patients with POAF after cardiac surgery have an increased long‐term risk of stroke and other adverse events. Methods and Results We prospectively followed for up...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-06-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.020426 |
| _version_ | 1811334077257613312 |
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| author | David Conen Michael K. Wang P. J. Devereaux Richard Whitlock William F. McIntyre Jeff S. Healey Fei Yuan Salim Yusuf Andre Lamy |
| author_facet | David Conen Michael K. Wang P. J. Devereaux Richard Whitlock William F. McIntyre Jeff S. Healey Fei Yuan Salim Yusuf Andre Lamy |
| author_sort | David Conen |
| collection | DOAJ |
| description | Background Perioperative atrial fibrillation (POAF) is common in patients undergoing cardiac surgery. Conflicting evidence exists whether patients with POAF after cardiac surgery have an increased long‐term risk of stroke and other adverse events. Methods and Results We prospectively followed for up to 5 years 4624 patients without prior atrial fibrillation who underwent coronary artery bypass grafting in an international study. POAF was defined as atrial fibrillation that occurred during the initial hospitalization for surgery, lasted for ≥5 minutes, and required treatment. Outcomes assessed were a composite of death, nonfatal myocardial infarction or nonfatal stroke, and its individual components. Median age was 67 years, and 778 (16.8%) had an episode of POAF. The incidence of the composite outcome was 6.84 and 4.10 per 100 patient‐years in patients with and without POAF, and the incidence of stroke was 0.75 versus 0.45, respectively. The adjusted hazard ratios (aHRs) were 1.36 (95% CI, 1.16–1.59) for the composite outcome; 1.33 (95% CI, 1.10–1.61) for death; 1.58 (95% CI, 1.23–2.02) for myocardial infarction, and 1.27 (95% CI, 0.81–2.00) for stroke. In a landmark analysis excluding events of the initial hospital admission, the aHRs were 1.26 (95% CI, 1.03–1.54) for the composite outcome, 1.28 (95% CI, 1.03–1.59) for death, 1.70 (95% CI, 0.86–3.36) for myocardial infarction, and 1.07 (95% CI, 0.59–1.93) for stroke. At hospital discharge, 10.7% and 1.4% of patients with and without POAF received oral anticoagulation, respectively. Conclusions Patients with POAF after cardiac surgery had an increased long‐term risk of adverse outcomes, mainly death and myocardial infarction. The risk of stroke was low and not increased in patients with POAF. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00463294. |
| first_indexed | 2024-04-13T17:03:22Z |
| format | Article |
| id | doaj.art-865e1e3153ab4960861708fdd3367c5e |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T17:03:22Z |
| publishDate | 2021-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-865e1e3153ab4960861708fdd3367c5e2022-12-22T02:38:35ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-06-01101210.1161/JAHA.120.020426New‐Onset Perioperative Atrial Fibrillation After Coronary Artery Bypass Grafting and Long‐Term Risk of Adverse Events: An Analysis From the CORONARY TrialDavid Conen0Michael K. Wang1P. J. Devereaux2Richard Whitlock3William F. McIntyre4Jeff S. Healey5Fei Yuan6Salim Yusuf7Andre Lamy8Population Health Research Institute McMaster University Hamilton CanadaDepartment of Medicine McMaster University Hamilton Ontario CanadaPopulation Health Research Institute McMaster University Hamilton CanadaPopulation Health Research Institute McMaster University Hamilton CanadaPopulation Health Research Institute McMaster University Hamilton CanadaPopulation Health Research Institute McMaster University Hamilton CanadaPopulation Health Research Institute McMaster University Hamilton CanadaPopulation Health Research Institute McMaster University Hamilton CanadaPopulation Health Research Institute McMaster University Hamilton CanadaBackground Perioperative atrial fibrillation (POAF) is common in patients undergoing cardiac surgery. Conflicting evidence exists whether patients with POAF after cardiac surgery have an increased long‐term risk of stroke and other adverse events. Methods and Results We prospectively followed for up to 5 years 4624 patients without prior atrial fibrillation who underwent coronary artery bypass grafting in an international study. POAF was defined as atrial fibrillation that occurred during the initial hospitalization for surgery, lasted for ≥5 minutes, and required treatment. Outcomes assessed were a composite of death, nonfatal myocardial infarction or nonfatal stroke, and its individual components. Median age was 67 years, and 778 (16.8%) had an episode of POAF. The incidence of the composite outcome was 6.84 and 4.10 per 100 patient‐years in patients with and without POAF, and the incidence of stroke was 0.75 versus 0.45, respectively. The adjusted hazard ratios (aHRs) were 1.36 (95% CI, 1.16–1.59) for the composite outcome; 1.33 (95% CI, 1.10–1.61) for death; 1.58 (95% CI, 1.23–2.02) for myocardial infarction, and 1.27 (95% CI, 0.81–2.00) for stroke. In a landmark analysis excluding events of the initial hospital admission, the aHRs were 1.26 (95% CI, 1.03–1.54) for the composite outcome, 1.28 (95% CI, 1.03–1.59) for death, 1.70 (95% CI, 0.86–3.36) for myocardial infarction, and 1.07 (95% CI, 0.59–1.93) for stroke. At hospital discharge, 10.7% and 1.4% of patients with and without POAF received oral anticoagulation, respectively. Conclusions Patients with POAF after cardiac surgery had an increased long‐term risk of adverse outcomes, mainly death and myocardial infarction. The risk of stroke was low and not increased in patients with POAF. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00463294.https://www.ahajournals.org/doi/10.1161/JAHA.120.020426cardiac surgerycoronary artery diseasemyocardial infarctionperioperative atrial fibrillationstroke |
| spellingShingle | David Conen Michael K. Wang P. J. Devereaux Richard Whitlock William F. McIntyre Jeff S. Healey Fei Yuan Salim Yusuf Andre Lamy New‐Onset Perioperative Atrial Fibrillation After Coronary Artery Bypass Grafting and Long‐Term Risk of Adverse Events: An Analysis From the CORONARY Trial Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiac surgery coronary artery disease myocardial infarction perioperative atrial fibrillation stroke |
| title | New‐Onset Perioperative Atrial Fibrillation After Coronary Artery Bypass Grafting and Long‐Term Risk of Adverse Events: An Analysis From the CORONARY Trial |
| title_full | New‐Onset Perioperative Atrial Fibrillation After Coronary Artery Bypass Grafting and Long‐Term Risk of Adverse Events: An Analysis From the CORONARY Trial |
| title_fullStr | New‐Onset Perioperative Atrial Fibrillation After Coronary Artery Bypass Grafting and Long‐Term Risk of Adverse Events: An Analysis From the CORONARY Trial |
| title_full_unstemmed | New‐Onset Perioperative Atrial Fibrillation After Coronary Artery Bypass Grafting and Long‐Term Risk of Adverse Events: An Analysis From the CORONARY Trial |
| title_short | New‐Onset Perioperative Atrial Fibrillation After Coronary Artery Bypass Grafting and Long‐Term Risk of Adverse Events: An Analysis From the CORONARY Trial |
| title_sort | new onset perioperative atrial fibrillation after coronary artery bypass grafting and long term risk of adverse events an analysis from the coronary trial |
| topic | cardiac surgery coronary artery disease myocardial infarction perioperative atrial fibrillation stroke |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.020426 |
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