title: New-onset atrial fibrillation following coronary bypass surgery predicts long-term mortality: a systematic review and meta-analysis.
abstract: Atrial fibrillation (AF) is one of the most common postoperative complications following cardiac surgery. Recent evidence suggests that postoperative atrial fibrillation (POAF) may be more 'malignant' than previously thought, associated with follow-up mortality and morbidity. To evaluate the long-term survival of POAF versus No-POAF cohorts following coronary bypass surgery, the current meta-analysis with reconstructed individual patient data was performed. Electronic searches were performed using six databases from their inception to August 2014. Relevant studies with long-term survival data presented for POAF versus No-POAF were identified. Data were extracted by two independent reviewers and analysed according to predefined clinical endpoints. The pooled hazard ratio (HR) significantly favoured higher survival in No-POAF over POAF (HR 1.28; 95% CI, 1.19-1.37; I(2) = 96%; P < 0.00001). Individual patient data of 69 518 patients were available for inverted Kaplan-Meier survival curve analysis. Analysis of aggregate data using Kaplan-Meier curve methods for POAF versus No-POAF groups determined survival rates at the 1-year (95.7 vs 98%), 2-year (92.3 vs 95.4%), 3-year (88.7 vs 93.9%), 5-year (82.6 vs 89.4%) and 10-year (65.5 vs 75.3%) follow-up. Other complications including 30-day mortality, strokes, respiratory failure, pneumonia and hospitalization were significantly higher in the POAF group. New-onset AF following coronary bypass surgery is associated with significantly higher risk of mortality in short- and long-term follow-up. Current evidence suggests the need for stricter surveillance and monitoring of POAF following coronary bypass surgery.
authors.affiliation: The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia Department of Cardiology, Westmead Hospital, Sydney, Australia St Vincent's Clinical School, The University of New South Wales, Sydney, Australia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Phan
authors.affiliation: St Vincent's Clinical School, The University of New South Wales, Sydney, Australia.
authors.forename: Hakeem S K
authors.initials: HS
authors.lastname: Ha
authors.affiliation: The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.
authors.forename: Steven
authors.initials: S
authors.lastname: Phan
authors.affiliation: Department of Cardiothoracic Surgery and Cardiology, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
authors.forename: Caroline
authors.initials: C
authors.lastname: Medi
authors.affiliation: Department of Cardiology, Westmead Hospital, Sydney, Australia.
authors.forename: Stuart P
authors.initials: SP
authors.lastname: Thomas
authors.affiliation: The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia Department of Cardiothoracic Surgery and Cardiology, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia tristanyan@annalscts.com.
authors.forename: Tristan D
authors.initials: TD
authors.lastname: Yan
mesh_terms: D001281:Atrial Fibrillation / Q000209:etiology / Q000401:mortality*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016019:Survival Analysis
keywords: Atrial fibrillation; Coronary bypass; Meta-analysis; Outcomes