Left Atrial Diameter Index Predicts Cerebrovascular Events After POAF Following CABG.

Objective To research the influencing factors of postoperative atrial fibrillation(AF) in patients underwent coronary artery bypass grafting(CABG), and to explore the relationship between postoperative AF with complications and recovery. Methods From January 2017 to February 2018, 2 218 patients in Beijing Anzhen Hospital affiliated to Capital Medical University underwent simple CABG and returned to the ICU. After excluding preoperative AF and pacemaker implanted patients, a total of 1 952 patients were included in the research. According to whether there was postoperative AF, patients were divided into non-AF group [1 544 cases, male 1 017, female 527, averaged age(63.20±9.47)years old]and new-onset AF group [408 cases, male 280, female 128, averaged age(69.32±8.93) years old]. The gender, age, related medical history, cardiac function and other factors were recorded. And the postoperative laboratory test indicators, tracheal reintubation rate, tracheotomy rate, mortality, IABP and ECMO use rate, intensive care unit and hospital time were compared. Results Compared with the non-AF group, the rates of tracheal reintubation(P=0.007), tracheotomy(P=0.039), and hospital mortality(P=0.039) were higher on the new-onset AF group, and the postoperative mechanical ventilation time(P=0.010), the ICU time(P=0.037) and the hospital time(P=0.045) were longer. Multivariate regression analysis showed: advanced age(P=0.028), postoperative cardiogenic shock(P=0.033), postoperative AKI(P=0.041), postoperative CRP elevation(P=0.030), postoperative TNI elevation(P=0.028) and postoperative LAC elevation(P=0.044) were independent risk factors for postoperative new-onset AF in CABG patients. Conclusion Patients with new-onset AF after CABG have higher complication and mortality rate. It is necessary to prevent the occurrence of AF and improve the heart and vital organ function in time to reduce the mortality. Key words: Atrial fibrillation Coronary artery bypass grafting

New-onset postoperative atrial fibrillation (POAF) is a common complication of coronary artery bypass graft (CABG) surgery. However, the long-term risk of thromboembolism in patients who develop POAF after CABG surgery remains unknown. In addition, information on stroke prophylaxis in this setting is lacking. To examine stroke prophylaxis and the long-term risk of thromboembolism in patients with new-onset POAF after first-time isolated CABG surgery compared with patients with nonsurgical, nonvalvular atrial fibrillation (NVAF). This cohort study used data from a clinical cardiac surgery database and Danish nationwide registries to identify patients undergoing first-time isolated CABG surgery who developed new-onset POAF from January 1, 2000, through June 30, 2015. These patients were matched by age, sex, CHA2DS2-VASc score, and year of diagnosis to patients with nonsurgical NVAF in a 1 to 4 ratio. Data analysis was completed from February 2017 to January 2018. The proportion of patients initiating oral anticoagulation therapy within 30 days and the rates of thromboembolism. A total of 2108 patients who developed POAF after CABG surgery were matched with 8432 patients with NVAF. In the full population of 10 540 patients, the median (interquartile range) age was 69.2 (63.7-74.7) years; 8675 patients (82.3%) were men. Oral anticoagulation therapy was initiated within 30 days postdischarge in 175 patients with POAF (8.4%) and 3549 patients with NVAF (42.9%). The risk of thromboembolism was lower in the POAF group than in the NVAF group (18.3 vs 29.7 events per 1000 person-years; adjusted hazard ratio [HR], 0.67; 95% CI, 0.55-0.81; P < .001). Anticoagulation therapy during follow-up was associated with a lower risk of thromboembolic events in both patients with POAF (adjusted HR, 0.55; 95% CI, 0.32-0.95; P = .03) and NVAF (adjusted HR, 0.59; 95% CI, 0.51-0.68; P < .001) compared with patients who did not receive any anticoagulation therapy. Further, the risk of thromboembolism was not significantly higher in patients with POAF compared with those who did not develop POAF after CABG surgery (adjusted HR, 1.11; 95% CI, 0.94-1.32; P < .24). New-onset POAF in patients who had undergone CABG surgery was associated with a lower long-term thromboembolic risk than that of patients who had NVAF. These data do not support the notion that new-onset POAF should be regarded as equivalent to primary NVAF in terms of long-term thromboembolic risk.

Postoperative atrial fibrillation (AF) is the most common complication after coronary artery bypass graft (CABG) surgery, with an incidence of 20%-50%. The objective of this study was to investigate perioperative risk factors of postoperative sustained AF by the way of logistic regression analysis. Data for the last 98 patients who had undergone CABG surgery before January 2010 were retrospectively collected and analyzed. Postoperative sustained AF was detected in 34 (34.7%) patients. Mean arterial blood pressure, previous hypertension (HT), previous AF, previous chronic obstructive pulmonary disease, aortic cross-clamp time, cardiopulmonary bypass time, postoperative urea, postoperative creatinine, postoperative potassium, extubation time, chest tube drainage, units of transfused packed red blood cells (pRBC), and postoperative pneumonia were associated with higher occurrence of postoperative sustained AF according to the univariate analysis. Upon logistic regression analysis, pRBC transfusion, previous AF, and preoperative HT remained independent predictors for the development of postoperative sustained AF. On-pump versus off-pump CABG is not significantly associated with AF development so long as the operating time does not extend over a certain time period. pRBC transfusion was the single risk factor that is amenable to intervention at the time of operation. Unneeded transfusion of pRBCs must be prohibited. Also, serious precautions must be taken against postoperative pneumonia to avoid postoperative AF occurrence.

Post-operative atrial fibrillation (POAF) is the most common cardiac arrhythmia occurring after coronary artery bypass grafting (CABG). Arrhythmia leads to prolonged hospitalisation and may have an impact on both short-term and long-term prognoses. The aim of this paper was to evaluate the incidence of POAF in patients after CABG as well as to identify its predictors. The study was performed on 791 patients (selected from a group of 1031 patients who underwent CABG in the Clinical Department of Cardiology in the years 2009-2011) who did not suffer from atrial fibrillation (AF) prior to isolated CABG. Data on co-existing diseases, as well as data collected at the time of surgery and in the post-operative period, were evaluated. The average age of patients in the examined group was 64.6 ± 9.1 years. Emergency CABG was performed on 38% of patients, whereas 75.1% of patients underwent CABG with the use of extracorporeal circulation. Based on the incidence of POAF, the post-CABG patients were classified into a POAF(+) group that comprised 166 (21%) patients, and a POAF(-) group involving 625 (79%) patients. The first occurrence of arrhythmia during the first three days after surgery was observed in 76.5% of patients. The average age of POAF(+) and POAF(-) patients was 68.7 ± 8.8 years and 63.5 ± 8.9 years, respectively (p < 0.0001). The respective incidence rates of co-existing diseases in patients with POAF and those without POAF were as follows: arterial hypertension, 80.1% vs. 75.8% (p = 0.29); heart failure, 18.7% vs. 21.1% (p = 0.56); type 2 diabetes, 24.1% vs. 26.2% (p = 0.64). Stable angina pectoris was diagnosed in 22.3% of patients with POAF and 15% of patients without POAF (p = 0.034). The following conditions were more frequently observed in patients with POAF compared with those without POAF: low cardiac output syndrome, 28.9% vs. 14.2% (p < 0.0001) and cardiac tamponade, 9% vs. 4.6% (p = 0.044), respectively. Red blood cell transfusions were performed more often in patients with POAF compared to those without POAF (70.5% vs. 55.7%, respectively, p = 0.0008). Multivariate analysis revealed the following potential predictors of POAF: age ≥ 70 years (HR 2.3), preoperative stable angina pectoris (HR 1.7), and post-CABG low cardiac output syndrome (HR 1.8). POAF was diagnosed in 21% of post-CABG patients, and the major predictors were: age ≥ 70 years, preoperative stable angina, as well as low cardiac output syndrome following CABG.

Invited commentary

THE IMPACT OF STATIN ON POST-OPERATIVE ATRIAL FIBRILLATION AFTER DISCHARGE FROM CARDIAC SURGERY: SECONDARY ANALYSIS OF THE SEARCH-AF CARDIOLINK-1 RANDOMIZED TRIAL

Background/Objectives: Postoperative atrial fibrillation (POAF) is a common and serious complication after coronary artery bypass grafting (CABG), leading to increased morbidity and healthcare utilization. Although systemic inflammation is a well-established driver of POAF pathogenesis, no composite preoperative inflammatory biomarker has been validated for risk stratification in this population. This study aimed to evaluate the novel Inflammatory Burden Index (IBI)-the first composite biomarker combining acute-phase (C-reactive protein, CRP) and chronic cellular (neutrophil-to-lymphocyte ratio, NLR) inflammation-as a preoperative predictor of POAF after CABG. Methods: In this large retrospective cohort study, we included 3481 consecutive patients who underwent isolated CABG at a high-volume cardiac center between 2019 and 2024. Preoperative IBI was calculated as CRP (mg/dL) × NLR. The primary outcome was new-onset POAF within the first 7 postoperative days, confirmed by continuous telemetry on 12-lead ECG. Predictive performance was assessed using multivariable logistic regression, receiver operating characteristic (ROC) curve analysis (area under the curve, AUC), net reclassification improvement (NRI), integrated discrimination improvement (IDI), and internal validation via bootstrapping (1000 resamples). Results: POAF developed in 866 patients (24.9%). Patients with POAF exhibited significantly higher preoperative IBI levels (39.4 ± 18.6 vs. 26.3 ± 16.7, p < 0.01). In multivariable analysis adjusted for age, hypertension, left atrial diameter, and other clinical covariates, IBI emerged as a strong independent predictor of POAF (adjusted OR 1.041, 95% CI 1.036-1.046, p < 0.01). The IBI alone demonstrated moderate-to-good discriminative performance (AUC 0.72, 95% CI 0.70-0.74), significantly outperforming the Systemic Immune/Inflammation Index (SII; AUC 0.61, DeLong test p < 0.001) and providing superior reclassification (NRI 0.150, IDI 0.032) and model fit (lower AIC). Combining IBI with established clinical risk factors further improved predictive accuracy (combined AUC 0.74, specificity 72.4%). Tertile-based stratification revealed a clear graded relationship with POAF incidence (low IBI: 16.6%, medium: 21.3%, high: 35.1%; p = 0.02). Notably, the medium IBI stratum (11.18-25.44) displayed the highest discriminative power (AUC 0.87, 95% CI 0.85-0.88), with bootstrap validation confirming model stability (minimal bias, robust 95% CI). Conclusions: This study establishes the preoperative Inflammatory Burden Index (IBI) as the first validated composite inflammatory biomarker independently associated with POAF following CABG. Its superior performance over existing indices (SII), graded risk stratification, and peak accuracy in the moderate inflammation window highlight its potential for personalized preoperative risk assessment and targeted perioperative intervention strategies.

BackgroundThe long‐term impact of new‐onset postoperative atrial fibrillation (POAF) after coronary artery bypass grafting and the benefit of early‐initiated oral anticoagulation (OAC) in patients with POAF are uncertain.Methods and ResultsAll patients who underwent coronary artery bypass grafting without preoperative atrial fibrillation in Sweden from 2007 to 2015 were included in a population‐based study using data from 4 national registries: SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence‐based Care in Heart Disease Evaluated According to Recommended Therapies), National Patient Registry, Dispensed Drug Registry, and Cause of Death Registry. POAF was defined as any new‐onset atrial fibrillation during the first 30 postoperative days. Cox regression models (adjusted for age, sex, comorbidity, and medication) were used to assess long‐term outcome in patients with and without POAF, and potential associations between early‐initiated OAC and outcome. In a cohort of 24 523 patients with coronary artery bypass grafting, POAF occurred in 7368 patients (30.0%), and 1770 (24.0%) of them were prescribed OAC within 30 days after surgery. During follow‐up (median 4.5 years, range 0‒9 years), POAF was associated with increased risk of ischemic stroke (adjusted hazard ratio [aHR] 1.18 [95% CI, 1.05‒1.32]), any thromboembolism (ischemic stroke, transient ischemic attack, or peripheral arterial embolism) (aHR 1.16, 1.05‒1.28), heart failure hospitalization (aHR 1.35, 1.21‒1.51), and recurrent atrial fibrillation (aHR 4.16, 3.76‒4.60), but not with all‐cause mortality (aHR 1.08, 0.98‒1.18). Early initiation of OAC was not associated with reduced risk of ischemic stroke or any thromboembolism but with increased risk for major bleeding (aHR 1.40, 1.08‒1.82).ConclusionsPOAF after coronary artery bypass grafting is associated with negative prognostic impact. The role of early OAC therapy remains unclear. Studies aiming at reducing the occurrence of POAF and its consequences are warranted.

Aim: This Department of Veterans Affairs’ (VA) research project evaluated the impact of postoperative atrial fibrillation (POAF) upon 10-year outcomes for coronary artery bypass grafting (CABG) patients. Methods: Veterans enrolled in the “Randomized On-/Off-pump Bypass” (ROOBY) trial with new-onset POAF post-CABG were compared to those without POAF with respect to 10-year atrial fibrillation (AF) and mortality rates. Multivariable logistic regression examined whether AF was independently associated with 10-year survival after holding other preoperative risk factors constant. Results: Of the 2203 ROOBY veterans enrolled at 18 VA medical centers from 2002 to 2008, 100 patients with preoperative AF (n = 93) or unknown post-CABG POAF status (n = 7) were excluded. The POAF rate was 26.2% (n = 551/2103). The POAF patients were older and had more co-morbidities than the non-POAF patients (n = 1552). The AF rate among 10-year ROOBY POAF survivors was 18.9% (n = 64/338) compared to 5.8% (n = 61/1048) for non-POAF patients; P &lt; 0.001. Compared to non-POAF patients’ 10-year survival of 70%, the ROOBY POAF veterans’ 10-year survival rate was 63%. Baseline risks inversely associated with 10-year survival included age, chronic obstructive pulmonary disease, serum creatinine &gt; 1.5, peripheral vascular disease, and smoking. Holding these factors constant, POAF was not independently associated with 10-year survival. Conclusion: Post-CABG, ROOBY POAF veterans had higher rates of 10-year AF, which was negatively associated with 10-year survival; however, this association was not significant. Given that POAF may adversely impact 10-year AF rates, additional investigation appears warranted to improve future POAF patients’ care.

Introduction:Atrial fibrillation in postoperative period is common. Although the event of atrial fibrillation is associated with reduced cardiac output and its consequences and cerebrovascular events, its effect on outcome is not clearly documented. This study is done to evaluate the effect of atrial fibrillation on outcome of the operation.Materials and Methods:This is a retrospective case-control study. A total of 263 patients received coronary artery bypass grafting during this period. The data for demographics, comorbidities, preoperative medications, operative details, and echocardiographic parameters of left ventricular functions were acquired. A total of 24 patients had atrial fibrillation (Group I), while 239 remained in normal sinus rhythm (Group II). The outcome is measured as combined of death and postoperative myocardial infarction (MI).Results:The groups are comparable in demographic, preoperative medications, operative, and left ventricular parameters. Of the 24 (9.12%) patients who had postoperative atrial fibrillation, 11 were discharged on medical management. Nine patients reverted to sinus rhythm at discharge. Atrial fibrillation persisted in 8 patients 1 week after discharge and 3 patients after 1 month. The requirement of intraaortic balloon pump (IABP) was statistically significant in group I (5 in group I vs. 10 in group II, n = 0.001). There were 4 deaths in group 1 and 7 in group 2 (P = 0.002), however, the combined end point was achieved in 4 (16.6%) vs. 22 (9.2%), respectively, P = 0.1.Conclusion:The appearance of atrial fibrillation heralds increased requirement of IABP, MI, and death in patients undergoing coronary artery bypass grafting.

Atrial fibrillation is the most common complication of cardiac surgery and is associated with significant morbidity and mortality. Recognizing patients at high risk for developing postoperative atrial fibrillation (POAF) may help identify those who could benefit from strategies to prevent POAF. This study was conducted to delineate outcomes and to assess risk factors for POAF among Taiwanese patients undergoing coronary artery bypass grafting (CABG). From January 2009 until February 2012, this prospective study included 266 consecutive patients admitted to our hospital with coronary artery disease. All patients underwent isolated CABG. Patients with preoperative permanent atrial fibrillation and concomitant surgery were excluded. Multiple risk factors associated with the incidence of POAF were collected and evaluated. POAF occurred in 126 of 226 patients (47.37%). Univariate analysis revealed that significant risk factors for the condition were age, gender, diabetes, dyslipidemia, smoking, impaired renal function, impaired cardiac function, and increased serum electrolytes. Multivariate analysis showed dyslipidemia [hazard ratio (HR): 0.418; 95% confidence interval (Cl): 0.190-0.915, p = 0.029], impaired renal function as indicated by an estimated glomerular filtration rate < 60 mL/min/1.73 m(2) (HR: 3.174; 95% CI: 1.432-7.037, p = 0.004), and serum sodium (HR: 1.112; 95% Cl: 1.047-1.182, p = 0.001) prior to cardiopulmonary bypass as significant. Moreover, POAF was associated with lower 30-day, 1- and 3-year cumulative survival rates and higher early postoperative complications. Patients with isolated CABG who were administered β-blockers, angiotensin converting enzyme inhibitor/angiotensin receptor blockers treatment, and lipid therapy before CABG were associated with reduced POAF, while those with impaired renal function and higher serum sodium before CABG predisposed POAF in a Taiwanese population. Atrial fibrillation (AF); Coronary artery bypass grafting (CABG); Coronary artery disease (CAD); Postoperative atrial fibrillation (POAF).

New-onset atrial fibrillation predicts long-term newly developed atrial fibrillation after coronary artery bypass graft

Preoperative inflammatory profile in chronic coronary syndrome reveals interleukin-2 as a promising biomarker for postoperative atrial fibrillation risk stratification

A substantial number of patients without a history of atrial fibrillation who undergo surgery develop one or more episodes of atrial fibrillation in the first few days after the operation. We studied whether postoperative transient atrial fibrillation is a risk factor for future atrial fibrillation, stroke and death. We performed a narrative review of the literature on epidemiology, mechanisms, risk of atrial fibrillation, stroke and death after postoperative atrial fibrillation. We reviewed antithrombotic guidelines on this topic and identified gaps in current management. Patients with postoperative atrial fibrillation are at high risk of developing atrial fibrillation in the long term. Mortality is also increased. Most, but not all observational studies report a higher risk of stroke. The optimal antithrombotic regimen for patients with postoperative atrial fibrillation has not been defined. The role of lifestyle changes and of surgical occlusion of the left atrial appendage in preventing adverse outcomes after postoperative atrial fibrillation is not established. Further studies are warranted to establish the optimal strategy to prevent adverse long-term outcomes after transient, postoperative atrial fibrillation.

BackgroundPostoperative atrial fibrillation occurs in up to 30% of patients after coronary artery bypass graft (CABG) and its cause is unknown. The aim of the study was to evaluate whether concentration of resistin in surrounding coronary artery perivascular adipose tissue (PVAT) is related to postoperative atrial fibrillation occurrence.MethodsA total number of 46 patients (35 male, 11 female; median age 66.5) were qualified for elective CABG. Medical history, laboratory test results and echocardiographic parameters were noted. Patients were monitored up to 3 days after CABG and then were divided into groups with and without postoperative atrial fibrillation occurrence. Fragments of PVAT were collected intra-operatively: near the left anterior descending artery and main left coronary artery. The concentration of resistin was determined by Human Resistin Quantikine ELISA Kit and expressed as ng/g. A multivariate stepwise logistic regression analysis was performed to find variables related to postoperative atrial fibrillation occurrence.ResultsPostoperative atrial fibrillation occurred in 14 (30.4%) patients. The patients with and without postoperative atrial fibrillation were similar in age, gender, epicardial adipose tissue thickness and laboratory parameters. The concentration of resistin in PVAT near the left main coronary artery was significantly higher in patients with postoperative atrial fibrillation than in those without the complication (P = 0.03). In the multivariate stepwise logistic regression analysis the concentration of resistin above cut-off point 54 ng/g in PVAT near left main coronary artery was independently related to postoperative atrial fibrillation occurrence (OR: 7.7; 95% CI:1.4–42.2 p = 0.02).ConclusionsThe higher concentrations of resistin in PVAT near the left main coronary artery which is located close to the left atrium are associated with postoperative atrial fibrillation.