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Mohammed A. Quader
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Ann Thorac Surg 2004;77:1514-1524
© 2004 The Society of Thoracic Surgeons

Original article: cardiovascular

Does preoperative atrial fibrillation reduce survival after coronary artery bypass grafting?

Mohammed A. Quader, MDa, Patrick M. McCarthy, MDa*, A. Marc Gillinov, MDa, Joan M. Alster, MSb, Delos M. Cosgrove, III, MDa, Bruce W. Lytle, MDa, Eugene H. Blackstone, MDa,b

a Department of Thoracic and Cardiovascular Surgery, Cleveland, Ohio USA
b Department of Biostatistics and Epidemiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA

Accepted for publication September 5, 2003.

* Address reprint requests to Dr McCarthy, Department of Thoracic and Cardiovascular Surgery, 9500 Euclid Ave, F25, Cleveland, OH, USA 44195
e-mail: mccartp{at}ccf.org

Presented at the Thirty-ninth Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31–Feb 2, 2003.

BACKGROUND: Preoperative atrial fibrillation has been identified as a risk factor for reduced long-term survival after coronary artery bypass grafting. This study sought to determine whether atrial fibrillation is merely a marker for high-risk patients or an independent risk factor for time-related mortality.

METHODS: From 1972 to 2000, 46,984 patients underwent primary isolated coronary artery bypass grafting; 451 (0.96% prevalence) had electrocardiogram-documented preoperative atrial fibrillation (n = 411) or flutter (n = 40). Characteristics of patients with and without atrial fibrillation were contrasted by multivariable logistic regression to form a propensity score. With this, comparable groups with and without atrial fibrillation were formed by pairwise propensity-matching to assess survival.

RESULTS: Patients with preoperative atrial fibrillation were older (67 ± 9.0 versus 59 ± 9.8 years, p < 0.0001), had more left ventricular dysfunction (66% versus 52%, p < 0.0001) and hypertension (73% versus 59%, p < 0.0001), but less severe angina (39% moderate or severe versus 49%, p < 0.0001). Many of these factors are themselves predictors of increased time-related mortality. In propensity-matched patients, survival at 30 days and at 5 and 10 years for patients with versus without atrial fibrillation was 97% versus 99%, 68% versus 85%, and 42% versus 66%, respectively, a survival difference at 10 years of 24%. Median survival in patients with atrial fibrillation was 8.7 years versus 14 years for those without it.

CONCLUSIONS: Atrial fibrillation in patients undergoing coronary artery bypass grafting is a marker for high-risk patients; in addition, atrial fibrillation itself substantially reduces long-term survival. Thus, if patients in atrial fibrillation require surgical revascularization, it is appropriate to consider performing a concomitant surgical ablation procedure.




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