Short- and long-term mortality associated with new-onset atrial fibrillation after coronary artery bypass grafting: a systematic review and meta-analysis.
OBJECTIVE
Our objectives were to evaluate short- and long-term mortality associated with new-onset atrial fibrillation after coronary artery bypass grafting and to identify preoperative and intraoperative patient characteristics associated with new-onset atrial fibrillation.


METHODS
Three independent investigators comprehensively reviewed the literature using Medline from 1960, Web of Science from 1980, and Scopus from 1960. All searches were done through December 2009. Selected cohort studies were used to evaluate associations between new-onset atrial fibrillation after coronary artery bypass grafting or coronary bypass plus valve and short-term mortality (defined as 30-day or in-hospital mortality) and long-term mortality (defined as mortality ≥ 6 months). We excluded studies involving atrial flutter, off-pump coronary bypass, and isolated valve surgery. Heterogeneity among studies was accounted for by meta-analysis with random-effects models.


RESULTS
Eleven studies (n = 40,112) met our inclusion criteria. New-onset atrial fibrillation was associated with higher short-term mortality (3.6% vs 1.9%; odds ratio [OR], 2.29; 95% confidence interval [CI], 1.74-3.01; P < .00001; heterogeneity of effects, P = .002). Mortality risks at 1 year and 4 years were 2.56 (95% CI, 2.14-3.08) and 2.19 (95% CI, 1.97-2.45; P < .0001), respectively. Older age, lower ejection fraction, history of hypertension, heart failure, prior stroke, peripheral arterial disease, and longer cardiopulmonary bypass and aortic clamp times were associated with new-onset atrial fibrillation. Preoperative use of ß-blockers reduced occurrence of new-onset atrial fibrillation (OR, 0.94 [95% CI, 0.88-1.01; P = .08]), whereas angiotensin-converting enzyme inhibitors increased it (OR, 1.20 [95% CI, 1.11-1.29], P < .00001).


CONCLUSIONS
New-onset atrial fibrillation after coronary artery bypass grafting appears to increase short- and long-term mortality. Preoperative use of ß-blockers, avoidance of angiotensin-converting enzyme inhibitors, and shorter cardiopulmonary bypass and aortic clamp times potentially reduce occurrence of new-onset atrial fibrillation.
Department of Hospital Medicine, Medicine Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA. Kawr@ccf.org
Roop
R
Kaw
Adrian V
AV
Hernandez
Iqbal
I
Masood
A Marc
AM
Gillinov
Walid
W
Saliba
Eugene H
EH
Blackstone
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects; D001011:Aorta / Q000601:surgery; D001281:Atrial Fibrillation / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D016009:Chi-Square Distribution; D003250:Constriction; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors