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Postcoronary Artery Bypass Graft Atrial Fibrillation Event Count and Survival: Differences by Sex.

MedStar author(s):

0003-4975

Name of journal: The Annals of thoracic surgeryAbstract: BACKGROUND: New-onset post-coronary artery bypass graft surgery (CABG) atrial fibrillation (AF) is associated with poor outcomes, but data on the effects of its characteristics are lacking and conflicting. We examined the effect number of post-CABG AF events has on long-term mortality risk, and whether this is sex dependent.CONCLUSIONS: Both men and women who experienced >=2 post-CABG AF episodes showed increased risk of five-year mortality, independent of total AF duration. While men's risk increased as number of AF events increased, women's peaked at 2 AF events. Future research needs to determine whether this divergence stems from differences in treatment/management, or underlying biology. Copyright (c) 2019. Published by Elsevier Inc.METHODS: Routinely-collected Society of Thoracic Surgeons (STS) data were supplemented with details on new-onset post-CABG AF (detected in-hospital via continuous ECG/telemetry monitoring) and long-term survival for 9,203 consecutive isolated-CABG patients (2002-2010). Using Cox regression, we determined the propensity-adjusted (STS-recognized risk factors) effect of number of AF events on survival, testing for effect modification by sex and controlling for AF duration.RESULTS: AF occurred in 739 (29.4%) women and 2,157 (32.3%) men (p<0.001). Adjusted results showed >=2 AF events significantly (p<.0001) increased 5-year mortality risk, independently of total AF duration. However, mortality risk differed between the sexes (p<.0001): women with 2 AF episodes had the greatest increase (hazard ratio [HR]; 95% confidence interval [CI]: 2.98; 1.43,4.83, vs. women without AF), followed by women and men with >=4 AF events (HR; 95%CI: 2.76; 1.27,4.55 and 2.73; 2.30,3.19, respectively). A single post-CABG AF episode was not associated with increased mortality risk.All authors: Ailawadi G, da Graca B, Damiano RJ Jr, Edgerton JR, Filardo G, Phan TK, Pollock BD, Thourani VOriginally published: Annals of Thoracic Surgery. 2019 Oct 04Fiscal year: FY2020Digital Object Identifier:

https://dx.doi.org/10.1016/j.athoracsur.2019.08.098

Date added to catalog: 2019-10-14

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Title notes ( 5 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	31589856	Available		31589856

BACKGROUND: New-onset post-coronary artery bypass graft surgery (CABG) atrial fibrillation (AF) is associated with poor outcomes, but data on the effects of its characteristics are lacking and conflicting. We examined the effect number of post-CABG AF events has on long-term mortality risk, and whether this is sex dependent.

CONCLUSIONS: Both men and women who experienced >=2 post-CABG AF episodes showed increased risk of five-year mortality, independent of total AF duration. While men's risk increased as number of AF events increased, women's peaked at 2 AF events. Future research needs to determine whether this divergence stems from differences in treatment/management, or underlying biology. Copyright (c) 2019. Published by Elsevier Inc.

METHODS: Routinely-collected Society of Thoracic Surgeons (STS) data were supplemented with details on new-onset post-CABG AF (detected in-hospital via continuous ECG/telemetry monitoring) and long-term survival for 9,203 consecutive isolated-CABG patients (2002-2010). Using Cox regression, we determined the propensity-adjusted (STS-recognized risk factors) effect of number of AF events on survival, testing for effect modification by sex and controlling for AF duration.

RESULTS: AF occurred in 739 (29.4%) women and 2,157 (32.3%) men (p<0.001). Adjusted results showed >=2 AF events significantly (p<.0001) increased 5-year mortality risk, independently of total AF duration. However, mortality risk differed between the sexes (p<.0001): women with 2 AF episodes had the greatest increase (hazard ratio [HR]; 95% confidence interval [CI]: 2.98; 1.43,4.83, vs. women without AF), followed by women and men with >=4 AF events (HR; 95%CI: 2.76; 1.27,4.55 and 2.73; 2.30,3.19, respectively). A single post-CABG AF episode was not associated with increased mortality risk.

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