Association of Postoperative Atrial Fibrillation Duration after Coronary Artery Bypass Grafting with Poor Postoperative Outcomes

² Department of Cardiovascular Surgery, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, 100037 Beijing, China

^*Correspondence: xiubinyang@hotmail.com (Xiubin Yang); kunhua@mail.ccmu.edu.cn (Kun Hua)
^†These authors contributed equally.

Rev. Cardiovasc. Med. 2024, 25(3), 98; https://doi.org/10.31083/j.rcm2503098

Submitted: 12 August 2023 | Revised: 4 October 2023 | Accepted: 16 October 2023 | Published: 8 March 2024

(This article belongs to the Special Issue Perioperative Management in Cardiac Surgery)

This is an open access article under the CC BY 4.0 license.

Abstract

Background: Postoperative atrial fibrillation (POAF) has long been associated with poor perioperative outcomes after coronary artery bypass grafting (CABG). In this study, we aimed to investigate the effect of prolonged POAF durations on perioperative outcomes of CABG. Methods: This retrospective cohort study examined CABG patients enrolled at Beijing Anzhen Hospital from January 2018 to September 2021. We compared patients with POAF durations $\geq$ 48 hours to patients with POAF durations $<$ 48 hours. Primary outcomes were in-hospital mortality, stroke, acute respiratory failure (ARF), acute kidney injury (AKI), and significant gastrointestinal bleeding (GIB); secondary outcomes were postoperative length of stay (LOS) and intensive care unit (ICU) duration. Associations between primary outcomes and POAF duration were determined using logistic regression and restricted cubic spline analyses. Differences in baseline characteristics were controlled using propensity score matching (PSM) and inverse probability of treatment weighting (IPTW). Results: Out of 11,848 CABG patients, 3604 (30.4%) had POAF, while 1131 (31.4%) had it for a duration of $\geq$ 48 hours. ARF (adjusted odds ratio [OR]: 2.96, 95% confidence interval [CI]: 1.47–6.09), AKI (adjusted OR: 2.37, 95% CI: 1.42–3.99), and significant GIB (adjusted OR: 2.60, 95% CI: 1.38–5.03) were associated with POAF durations $\geq$ 48 hours; however, neither in-hospital mortality (adjusted OR: 1.60, 95% CI: 0.97–2.65) nor stroke (adjusted OR: 1.28, 95% CI: 0.71–2.34) was. These results remained even following PSM and IPTW analyses. Conclusions: POAF durations longer than 48 hours were independently associated with poorer perioperative recovery from CABG, with respect to the occurrence of ARF, AKI, and GIB, as well as a longer postoperative LOS and ICU duration. However, it was not associated with greater in-hospital mortality or stroke occurrence. All these findings suggest that postoperative monitoring of POAF and positive intervention after detection may be more helpful in optimizing post-CABG patient outcomes.