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Original Articles

New-Onset Postoperative Atrial Fibrillation After Isolated Coronary Artery Bypass Graft Surgery and Long-Term Survival

Giovanni Filardo, PhD, MPH; Cody Hamilton, PhD; Robert F. Hebeler, Jr, MD; Baron Hamman, MD and Paul Grayburn, MD

From the Institute for Health Care Research and Improvement (G.F.), Baylor Research Institute, Dallas, Tex; the Department of Statistical Science (G.F.), Southern Methodist University, Dallas, Tex; the Department of Clinical Operations (C.H.), Edwards Lifesciences, Irvine, Calif; the Department of Cardiothoracic Surgery (R.F.H., B.H.), Baylor University Medical Center, Dallas, Tex; and Baylor Heart and Vascular Institute (P.G.), Baylor University Medical Center, Dallas, Tex.

Correspondence to Giovanni Filardo, PhD, MPH, Institute for Health Care Research and Improvement, 8080 North Central Expressway, Suite 500, Dallas, TX 76206. E-mail giovanfi{at}baylorhealth.edu

Received August 22, 2008; accepted January 9, 2009.

Background— The advancing age and generally increasing risk profile of patients receiving isolated coronary artery bypass graft (CABG) surgery is expected to raise incidence of new-onset postoperative atrial fibrillation (AFIB) resulting in potentially higher risk of adverse outcomes. In the early postoperative course, new-onset post-CABG AFIB is considered relatively easy to treat and is believed to have little impact on patients’ long-term outcome. However, little has been done to determine the effect of new-onset post-CABG AFIB on long-term survival, and this relationship is unclear.

Methods and Results— Survival was assessed in a cohort of 6899 consecutive patients without preoperative AFIB who underwent isolated CABG at Baylor University Medical Center, Dallas, Tex, between January 1, 1997 and December 31, 2006; patients who died during CABG were excluded. Ten-year unadjusted survival was 52.3% (48.4%, 56.0%) for patients with new-onset postoperative AFIB and 69.4% (67.3%, 71.4%) for patients without it. A propensity-adjusted model controlling for risk factors identified by the Society of Thoracic Surgeons and other clinical/nonclinical details was used to investigate the association between new-onset AFIB post-CABG and long-term survival. After adjustment, new-onset AFIB post-CABG was significantly associated (hazard ratio, 1.29; 95% CI, 1.16, 1.45) with increased risk of death.

Conclusions— This study provides evidence that new-onset post-CABG AFIB is significantly associated with increased long-term risk of mortality independent of patient preoperative severity. After controlling for a comprehensive array of risk factors associated with post-CABG adverse outcomes, risk of long-term mortality in patients that developed new-onset post-CABG AFIB was 29% higher than in patients without it.

Key Words: CABG • atrial fibrillation • coronary disease • mortality • survival