Postoperative Atrial Fibrillation and Long-Term Risk of Stroke After Isolated Coronary Artery Bypass Graft Surgery. Issue 14 (6th October 2020)

• Record Type: Journal Article
• Authors: Benedetto, Umberto; Gaudino, Mario F.; Dimagli, Arnaldo; Gerry, Stephen; Gray, Alastair; Lees, Belinda; Flather, Marcus; Taggart, David P.
• Is Part Of: Circulation. Volume 142:Issue 14(2020)
• Publication Date: 2020-10-06
• Subjects: atrial fibrillation -- coronary artery bypass -- stroke; Blood -- Circulation -- Periodicals; Cardiovascular system -- Periodicals; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; Blood Circulation; Cardiovascular System; Vascular Diseases; 616.1
• DOI: 10.1161/CIRCULATIONAHA.120.046940
• Languages: English
• ISSNs: 0009-7322

Abstract

Abstract : Background: Postoperative atrial fibrillation (pAF) after coronary artery bypass grafting is a common complication. Whether pAF is associated with an increased risk of cerebrovascular accident (CVA) remains uncertain. We investigated the association between pAF and long-term risk of CVA by performing a post hoc analysis of 10-year outcomes of the ART (Arterial Revascularization Trial). Methods: For the present analysis, among patients enrolled in the ART (n=3102), we excluded those who did not undergo surgery (n=25), had a history of atrial fibrillation (n=45), or had no information on the incidence of pAF (n=9). The final population consisted of 3023 patients, of whom 734 (24.3%) developed pAF with the remaining 2289 maintaining sinus rhythm. Competing risk and Cox regression analyses were used to investigate the association between pAF and the risk of CVA. Results: At 10 years, the cumulative incidence of CVA was 6.3% (4.6%–8.1%) versus 3.7% (2.9%–4.5%) in patients with pAF and sinus rhythm, respectively. pAF was an independent predictor of CVA at 10 years (hazard ratio, 1.53 [95% CI, 1.06–2.23]; P =0.025) even when CVAs that occurred during the index admission were excluded from the analysis (hazard ratio, 1.47 [95% 1.02–2.11]; P =0.04). Conclusions: Patients with pAF after coronary artery bypass grafting are at higher risk of CVA. These findings challenge the notion that pAF is a benign complication. Abstract : Supplemental Digital Content is available in the text.