Does preoperative atrial fibrillation influence early and late outcomes of coronary artery bypass grafting?

Dumbor L. Ngaage, Hartzell V Schaff, Charles J. Mullany, Thoralf M. Sundt, Joseph A. Dearani, Sunni Barnes, Richard C. Daly, Thomas A. Orszulak

Research output: Contribution to journalArticle

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Abstract

Objective: The study objective was to describe the independent effect of preoperative atrial fibrillation on the outcome of coronary artery bypass grafting, including the causes of death (cardiac vs noncardiac). Methods: We analyzed the outcome of patients with preoperative atrial fibrillation who underwent on-pump coronary artery bypass grafting between 1993 and 2002 and compared them with matched controls in sinus rhythm; matching variables were age, gender, ejection fraction, and numbers of diseased coronary arteries and distal anastomoses. Direct patient follow-up focused on late complications and reinterventions, and we investigated causes for all deaths. Results: Operative mortality (1.6% vs 1.9%, P = .79) was similar in patients with preoperative atrial fibrillation (n = 257) compared with patients in sinus rhythm (n = 269). The patients with atrial fibrillation had longer hospital stays (9 ± 6 days vs 8 ± 6 days, P = .0008) and a trend to more frequent early readmissions (13% vs 9%, P = .08). During follow-up (median 6.7 years, maximum 12 years), late hospital admission was more frequent in patients with atrial fibrillation (59% vs 31%, P < .0001). Risk of late mortality (all causes) in patients with atrial fibrillation was increased by 40% compared with patients in sinus rhythm (P = 0.02), and the late cardiac death rate in the atrial fibrillation group was 2.8 times that of the sinus rhythm group (P = .0004). Major adverse cardiac events occurred in 70% of patients with preoperative atrial fibrillation compared with 52% of patients in preoperative sinus rhythm (P < .0001). Subsequent rhythm-related intervention, including pacemaker implantations, was more common in the atrial fibrillation group (relative risk = 2.1, P = .0027). Conclusions: Uncorrected preoperative atrial fibrillation in patients undergoing coronary artery bypass grafting is associated with increased late cardiac morbidity and mortality and poor long-term survival. These data support consideration of atrial fibrillation surgery at the time of coronary artery bypass grafting.

Original languageEnglish (US)
Pages (from-to)182-189
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume133
Issue number1
DOIs
StatePublished - Jan 2007

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Coronary Artery Bypass
Atrial Fibrillation
Mortality
Cause of Death
Coronary Artery Disease
Length of Stay
Morbidity
Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Does preoperative atrial fibrillation influence early and late outcomes of coronary artery bypass grafting? / Ngaage, Dumbor L.; Schaff, Hartzell V; Mullany, Charles J.; Sundt, Thoralf M.; Dearani, Joseph A.; Barnes, Sunni; Daly, Richard C.; Orszulak, Thomas A.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 133, No. 1, 01.2007, p. 182-189.

Research output: Contribution to journalArticle

Ngaage, Dumbor L. ; Schaff, Hartzell V ; Mullany, Charles J. ; Sundt, Thoralf M. ; Dearani, Joseph A. ; Barnes, Sunni ; Daly, Richard C. ; Orszulak, Thomas A. / Does preoperative atrial fibrillation influence early and late outcomes of coronary artery bypass grafting?. In: Journal of Thoracic and Cardiovascular Surgery. 2007 ; Vol. 133, No. 1. pp. 182-189.
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abstract = "Objective: The study objective was to describe the independent effect of preoperative atrial fibrillation on the outcome of coronary artery bypass grafting, including the causes of death (cardiac vs noncardiac). Methods: We analyzed the outcome of patients with preoperative atrial fibrillation who underwent on-pump coronary artery bypass grafting between 1993 and 2002 and compared them with matched controls in sinus rhythm; matching variables were age, gender, ejection fraction, and numbers of diseased coronary arteries and distal anastomoses. Direct patient follow-up focused on late complications and reinterventions, and we investigated causes for all deaths. Results: Operative mortality (1.6{\%} vs 1.9{\%}, P = .79) was similar in patients with preoperative atrial fibrillation (n = 257) compared with patients in sinus rhythm (n = 269). The patients with atrial fibrillation had longer hospital stays (9 ± 6 days vs 8 ± 6 days, P = .0008) and a trend to more frequent early readmissions (13{\%} vs 9{\%}, P = .08). During follow-up (median 6.7 years, maximum 12 years), late hospital admission was more frequent in patients with atrial fibrillation (59{\%} vs 31{\%}, P < .0001). Risk of late mortality (all causes) in patients with atrial fibrillation was increased by 40{\%} compared with patients in sinus rhythm (P = 0.02), and the late cardiac death rate in the atrial fibrillation group was 2.8 times that of the sinus rhythm group (P = .0004). Major adverse cardiac events occurred in 70{\%} of patients with preoperative atrial fibrillation compared with 52{\%} of patients in preoperative sinus rhythm (P < .0001). Subsequent rhythm-related intervention, including pacemaker implantations, was more common in the atrial fibrillation group (relative risk = 2.1, P = .0027). Conclusions: Uncorrected preoperative atrial fibrillation in patients undergoing coronary artery bypass grafting is associated with increased late cardiac morbidity and mortality and poor long-term survival. These data support consideration of atrial fibrillation surgery at the time of coronary artery bypass grafting.",
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T1 - Does preoperative atrial fibrillation influence early and late outcomes of coronary artery bypass grafting?

AU - Ngaage, Dumbor L.

AU - Schaff, Hartzell V

AU - Mullany, Charles J.

AU - Sundt, Thoralf M.

AU - Dearani, Joseph A.

AU - Barnes, Sunni

AU - Daly, Richard C.

AU - Orszulak, Thomas A.

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N2 - Objective: The study objective was to describe the independent effect of preoperative atrial fibrillation on the outcome of coronary artery bypass grafting, including the causes of death (cardiac vs noncardiac). Methods: We analyzed the outcome of patients with preoperative atrial fibrillation who underwent on-pump coronary artery bypass grafting between 1993 and 2002 and compared them with matched controls in sinus rhythm; matching variables were age, gender, ejection fraction, and numbers of diseased coronary arteries and distal anastomoses. Direct patient follow-up focused on late complications and reinterventions, and we investigated causes for all deaths. Results: Operative mortality (1.6% vs 1.9%, P = .79) was similar in patients with preoperative atrial fibrillation (n = 257) compared with patients in sinus rhythm (n = 269). The patients with atrial fibrillation had longer hospital stays (9 ± 6 days vs 8 ± 6 days, P = .0008) and a trend to more frequent early readmissions (13% vs 9%, P = .08). During follow-up (median 6.7 years, maximum 12 years), late hospital admission was more frequent in patients with atrial fibrillation (59% vs 31%, P < .0001). Risk of late mortality (all causes) in patients with atrial fibrillation was increased by 40% compared with patients in sinus rhythm (P = 0.02), and the late cardiac death rate in the atrial fibrillation group was 2.8 times that of the sinus rhythm group (P = .0004). Major adverse cardiac events occurred in 70% of patients with preoperative atrial fibrillation compared with 52% of patients in preoperative sinus rhythm (P < .0001). Subsequent rhythm-related intervention, including pacemaker implantations, was more common in the atrial fibrillation group (relative risk = 2.1, P = .0027). Conclusions: Uncorrected preoperative atrial fibrillation in patients undergoing coronary artery bypass grafting is associated with increased late cardiac morbidity and mortality and poor long-term survival. These data support consideration of atrial fibrillation surgery at the time of coronary artery bypass grafting.

AB - Objective: The study objective was to describe the independent effect of preoperative atrial fibrillation on the outcome of coronary artery bypass grafting, including the causes of death (cardiac vs noncardiac). Methods: We analyzed the outcome of patients with preoperative atrial fibrillation who underwent on-pump coronary artery bypass grafting between 1993 and 2002 and compared them with matched controls in sinus rhythm; matching variables were age, gender, ejection fraction, and numbers of diseased coronary arteries and distal anastomoses. Direct patient follow-up focused on late complications and reinterventions, and we investigated causes for all deaths. Results: Operative mortality (1.6% vs 1.9%, P = .79) was similar in patients with preoperative atrial fibrillation (n = 257) compared with patients in sinus rhythm (n = 269). The patients with atrial fibrillation had longer hospital stays (9 ± 6 days vs 8 ± 6 days, P = .0008) and a trend to more frequent early readmissions (13% vs 9%, P = .08). During follow-up (median 6.7 years, maximum 12 years), late hospital admission was more frequent in patients with atrial fibrillation (59% vs 31%, P < .0001). Risk of late mortality (all causes) in patients with atrial fibrillation was increased by 40% compared with patients in sinus rhythm (P = 0.02), and the late cardiac death rate in the atrial fibrillation group was 2.8 times that of the sinus rhythm group (P = .0004). Major adverse cardiac events occurred in 70% of patients with preoperative atrial fibrillation compared with 52% of patients in preoperative sinus rhythm (P < .0001). Subsequent rhythm-related intervention, including pacemaker implantations, was more common in the atrial fibrillation group (relative risk = 2.1, P = .0027). Conclusions: Uncorrected preoperative atrial fibrillation in patients undergoing coronary artery bypass grafting is associated with increased late cardiac morbidity and mortality and poor long-term survival. These data support consideration of atrial fibrillation surgery at the time of coronary artery bypass grafting.

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