Burden of preoperative atrial fibrillation in patients undergoing coronary artery bypass grafting

S Chris Malaisrie*, Patrick M McCarthy, Jane Kruse, Roland Matsouaka, Adin-Cristian Andrei, Maria V. Grau-Sepulveda, Daniel J. Friedman, James Lewis Cox, J. Matthew Brennan

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: This study compares early and late outcomes in patients undergoing coronary artery bypass grafting with and without preoperative atrial fibrillation in a contemporary, nationally representative Medicare cohort. Methods: In the Medicare-Linked Society of Thoracic Surgeons database, 361,138 patients underwent isolated coronary artery bypass from 2006 to 2013, of whom 37,220 (10.3%) had preoperative atrial fibrillation; 13,161 (35.4%) were treated with surgical ablation and were excluded. Generalized estimating equations were used to compare 30-day mortality and morbidity. Long-term survival was summarized using Kaplan-Meier curves and Cox regression models. Stroke and systemic embolism incidence was modeled using the Fine-Gray model and the CHA2DS2-VASc score was used to analyze stroke risk. Median follow-up was 4 years. Results: Preoperative atrial fibrillation was associated with a higher adjusted in-hospital mortality (odds ratio [OR], 1.5; P <.0001) and combined major morbidity including stroke, renal failure, prolonged ventilation, reoperation, and deep sternal wound infection (OR, 1.32; P <.0001). Patients with preoperative atrial fibrillation experienced a higher adjusted long-term risk of all-cause mortality and cumulative risk of stroke and systemic embolism compared to those without atrial fibrillation. At 5 years, the survival probability in the preoperative atrial fibrillation versus no atrial fibrillation groups stratified by CHA2DS2-VASc scores was 74.8% versus 86.3% (score 1-3), 56.5% versus 73.2% (score 4-6), and 41.2% versus 57.2% (score 7-9; all P <.001). Conclusions: Preoperative atrial fibrillation is independently associated with worse early and late postoperative outcomes. CHA2DS2-VASc stratifies risk, even in those without preoperative atrial fibrillation.

Original languageEnglish (US)
Pages (from-to)2358-2367.e1
JournalJournal of Thoracic and Cardiovascular Surgery
Volume155
Issue number6
DOIs
StatePublished - Jun 1 2018

Fingerprint

Coronary Artery Bypass
Atrial Fibrillation
Stroke
Medicare
Embolism
Odds Ratio
Morbidity
Survival
Mortality
Wound Infection
Hospital Mortality
Reoperation
Proportional Hazards Models
Renal Insufficiency
Ventilation
Databases
Incidence

Keywords

  • atrial fibrillation
  • cardiac surgery

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Malaisrie, S Chris ; McCarthy, Patrick M ; Kruse, Jane ; Matsouaka, Roland ; Andrei, Adin-Cristian ; Grau-Sepulveda, Maria V. ; Friedman, Daniel J. ; Cox, James Lewis ; Brennan, J. Matthew. / Burden of preoperative atrial fibrillation in patients undergoing coronary artery bypass grafting. In: Journal of Thoracic and Cardiovascular Surgery. 2018 ; Vol. 155, No. 6. pp. 2358-2367.e1.
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abstract = "Background: This study compares early and late outcomes in patients undergoing coronary artery bypass grafting with and without preoperative atrial fibrillation in a contemporary, nationally representative Medicare cohort. Methods: In the Medicare-Linked Society of Thoracic Surgeons database, 361,138 patients underwent isolated coronary artery bypass from 2006 to 2013, of whom 37,220 (10.3{\%}) had preoperative atrial fibrillation; 13,161 (35.4{\%}) were treated with surgical ablation and were excluded. Generalized estimating equations were used to compare 30-day mortality and morbidity. Long-term survival was summarized using Kaplan-Meier curves and Cox regression models. Stroke and systemic embolism incidence was modeled using the Fine-Gray model and the CHA2DS2-VASc score was used to analyze stroke risk. Median follow-up was 4 years. Results: Preoperative atrial fibrillation was associated with a higher adjusted in-hospital mortality (odds ratio [OR], 1.5; P <.0001) and combined major morbidity including stroke, renal failure, prolonged ventilation, reoperation, and deep sternal wound infection (OR, 1.32; P <.0001). Patients with preoperative atrial fibrillation experienced a higher adjusted long-term risk of all-cause mortality and cumulative risk of stroke and systemic embolism compared to those without atrial fibrillation. At 5 years, the survival probability in the preoperative atrial fibrillation versus no atrial fibrillation groups stratified by CHA2DS2-VASc scores was 74.8{\%} versus 86.3{\%} (score 1-3), 56.5{\%} versus 73.2{\%} (score 4-6), and 41.2{\%} versus 57.2{\%} (score 7-9; all P <.001). Conclusions: Preoperative atrial fibrillation is independently associated with worse early and late postoperative outcomes. CHA2DS2-VASc stratifies risk, even in those without preoperative atrial fibrillation.",
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Burden of preoperative atrial fibrillation in patients undergoing coronary artery bypass grafting. / Malaisrie, S Chris; McCarthy, Patrick M; Kruse, Jane; Matsouaka, Roland; Andrei, Adin-Cristian; Grau-Sepulveda, Maria V.; Friedman, Daniel J.; Cox, James Lewis; Brennan, J. Matthew.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 155, No. 6, 01.06.2018, p. 2358-2367.e1.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Burden of preoperative atrial fibrillation in patients undergoing coronary artery bypass grafting

AU - Malaisrie, S Chris

AU - McCarthy, Patrick M

AU - Kruse, Jane

AU - Matsouaka, Roland

AU - Andrei, Adin-Cristian

AU - Grau-Sepulveda, Maria V.

AU - Friedman, Daniel J.

AU - Cox, James Lewis

AU - Brennan, J. Matthew

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Background: This study compares early and late outcomes in patients undergoing coronary artery bypass grafting with and without preoperative atrial fibrillation in a contemporary, nationally representative Medicare cohort. Methods: In the Medicare-Linked Society of Thoracic Surgeons database, 361,138 patients underwent isolated coronary artery bypass from 2006 to 2013, of whom 37,220 (10.3%) had preoperative atrial fibrillation; 13,161 (35.4%) were treated with surgical ablation and were excluded. Generalized estimating equations were used to compare 30-day mortality and morbidity. Long-term survival was summarized using Kaplan-Meier curves and Cox regression models. Stroke and systemic embolism incidence was modeled using the Fine-Gray model and the CHA2DS2-VASc score was used to analyze stroke risk. Median follow-up was 4 years. Results: Preoperative atrial fibrillation was associated with a higher adjusted in-hospital mortality (odds ratio [OR], 1.5; P <.0001) and combined major morbidity including stroke, renal failure, prolonged ventilation, reoperation, and deep sternal wound infection (OR, 1.32; P <.0001). Patients with preoperative atrial fibrillation experienced a higher adjusted long-term risk of all-cause mortality and cumulative risk of stroke and systemic embolism compared to those without atrial fibrillation. At 5 years, the survival probability in the preoperative atrial fibrillation versus no atrial fibrillation groups stratified by CHA2DS2-VASc scores was 74.8% versus 86.3% (score 1-3), 56.5% versus 73.2% (score 4-6), and 41.2% versus 57.2% (score 7-9; all P <.001). Conclusions: Preoperative atrial fibrillation is independently associated with worse early and late postoperative outcomes. CHA2DS2-VASc stratifies risk, even in those without preoperative atrial fibrillation.

AB - Background: This study compares early and late outcomes in patients undergoing coronary artery bypass grafting with and without preoperative atrial fibrillation in a contemporary, nationally representative Medicare cohort. Methods: In the Medicare-Linked Society of Thoracic Surgeons database, 361,138 patients underwent isolated coronary artery bypass from 2006 to 2013, of whom 37,220 (10.3%) had preoperative atrial fibrillation; 13,161 (35.4%) were treated with surgical ablation and were excluded. Generalized estimating equations were used to compare 30-day mortality and morbidity. Long-term survival was summarized using Kaplan-Meier curves and Cox regression models. Stroke and systemic embolism incidence was modeled using the Fine-Gray model and the CHA2DS2-VASc score was used to analyze stroke risk. Median follow-up was 4 years. Results: Preoperative atrial fibrillation was associated with a higher adjusted in-hospital mortality (odds ratio [OR], 1.5; P <.0001) and combined major morbidity including stroke, renal failure, prolonged ventilation, reoperation, and deep sternal wound infection (OR, 1.32; P <.0001). Patients with preoperative atrial fibrillation experienced a higher adjusted long-term risk of all-cause mortality and cumulative risk of stroke and systemic embolism compared to those without atrial fibrillation. At 5 years, the survival probability in the preoperative atrial fibrillation versus no atrial fibrillation groups stratified by CHA2DS2-VASc scores was 74.8% versus 86.3% (score 1-3), 56.5% versus 73.2% (score 4-6), and 41.2% versus 57.2% (score 7-9; all P <.001). Conclusions: Preoperative atrial fibrillation is independently associated with worse early and late postoperative outcomes. CHA2DS2-VASc stratifies risk, even in those without preoperative atrial fibrillation.

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