Long-Term Outcomes of Preoperative Atrial Fibrillation in Cardiac Surgery
Background: Atrial fibrillation (Afib) is a marker of increased cardiovascular morbidity and mortality. Owing to the increased prevalence of Afib in patients undergoing cardiac surgery, assessing the effect of Afib on postsurgical outcomes is important. We aimed to analyze the effect of preoperat...
Main Authors: | , , , , , , |
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Format: | Article |
Language: | English |
Published: |
Korean Society for Thoracic & Cardiovascular Surgery
2022-10-01
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Series: | Journal of Chest Surgery |
Subjects: |
Summary: | Background: Atrial fibrillation (Afib) is a marker of increased cardiovascular morbidity
and mortality. Owing to the increased prevalence of Afib in patients undergoing cardiac
surgery, assessing the effect of Afib on postsurgical outcomes is important. We aimed to
analyze the effect of preoperative Afib on clinical outcomes in patients undergoing cardiac
surgery using a large surgical database.
Methods: This retrospective cohort study was based on the national health claims database
established by the National Health Insurance Service of the Republic of Korea from
2009 to 2015. Diagnosis and procedure codes were used to identify diseases according to
the International Statistical Classification of Diseases, 10th revision.
Results: We included 1,037 patients (0.1%) who had undergone cardiac surgery from a
randomized 1,000,000-patient cohort, and 15 patients (1.5%) treated with isolated surgical
Afib ablation were excluded. Of these 1,022 patients, 412 (39.7%), 303 (29.2%), and 92 (9.0%)
underwent coronary artery bypass, heart valve surgery, and Cox-maze surgery, respectively.
Preoperative Afib was associated with higher patient mortality (p=0.028), regardless of
the surgical procedure. Patients with preoperative Afib (n=190, 18.6%) experienced a higher
cumulative risk of overall mortality (hazard ratio [HR], 1.435; 95% confidence interval [CI],
1.263–2.107; p=0.034). Subgroup analysis revealed a reduced risk of overall mortality with
Cox-maze surgery in Afib patients (HR, 0.500; 95% CI, 0.266–0.938; p=0.031). Postoperative
cerebral ischemia or hemorrhage events were not related to Afib.
Conclusion: Preoperative Afib was independently associated with worse long-term
postoperative outcomes after cardiac surgery. Concomitant Cox-maze surgery may improve
the survival rate. |
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ISSN: | 2765-1606 2765-1614 |