Document Detail

New-onset atrial fibrillation predicts long-term mortality after coronary artery bypass graft.
MedLine Citation:
PMID:  20338499     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: We sought to investigate the association between new-onset atrial fibrillation after coronary artery bypass graft (CABG) (post-operative atrial fibrillation [POAF]) and long-term mortality in patients with no history of atrial fibrillation. BACKGROUND: POAF predicts longer hospital stay and greater post-operative mortality. METHODS: A total of 16,169 consecutive patients with no history of AF who underwent isolated CABG at our institution between January 1, 1996, and December 31, 2007, were included in the study. All-cause mortality data were obtained from Social Security Administration death records. A multivariable Cox proportional hazards regression model was constructed to determine the independent impact of new-onset POAF on long-term survival after adjusting for several covariates. The covariates included age, sex, race, pre-operative risk factors (ejection fraction, New York Heart Association functional class, history of myocardial infarction, index myocardial infarction, stroke, chronic obstructive pulmonary disease, peripheral arterial disease, smoking, diabetes, renal failure, hypertension, dyslipidemia, creatinine level, dialysis, redo surgery, elective versus emergent CABG, any valvular disorder) and post-operative adverse events (stroke, myocardial infarction, acute respiratory distress syndrome, and renal failure), and discharge cardiac medications known to affect survival in patients with coronary disease. RESULTS: New-onset AF occurred in 2,985 (18.5%) patients undergoing CABG. POAF independently predicted long-term mortality (hazard ratio: 1.21; 95% confidence interval: 1.12 to 1.32) during a mean follow-up of 6 years (range 0 to 12.5 years). This association remained true after excluding from the analysis those patients who died in-hospital after surgery (hazard ratio: 1.21; 95% confidence interval: 1.11 to 1.32). Patients with POAF discharged on warfarin experienced reduced mortality during follow-up. CONCLUSIONS: In this large cohort of patients, POAF predicted long-term mortality. Warfarin anticoagulation may improve survival in POAF.
Mikhael F El-Chami; Patrick Kilgo; Vinod Thourani; Omar M Lattouf; David B Delurgio; Robert A Guyton; Angel R Leon; John D Puskas
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  55     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-26     Completed Date:  2010-04-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1370-6     Citation Subset:  AIM; IM    
Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia 30308, USA.
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MeSH Terms
Anticoagulants / therapeutic use
Atrial Fibrillation / mortality*
Coronary Artery Bypass / mortality*
Coronary Artery Disease / drug therapy,  epidemiology,  surgery
Georgia / epidemiology
Kaplan-Meiers Estimate
Middle Aged
Postoperative Complications / mortality*
Proportional Hazards Models
Retrospective Studies
Risk Factors
Warfarin / therapeutic use
Reg. No./Substance:
0/Anticoagulants; 81-81-2/Warfarin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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