Title: | Associations between new-onset postoperative atrial fibrillation and long-term outcome in patients undergoing surgical aortic valve replacement |
Author: |
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Date: | 2023-05-02 |
Language: | English |
Scope: | 1103387 |
Department: | Faculty of Medicine Other departments |
Series: | European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery; 63(5) |
ISSN: | 1010-7940 |
DOI: | 10.1093/ejcts/ezad103 |
Subject: | Hjarta- og lungnaskurðlæknisfræði; Aortic Valve/surgery; Atrial Fibrillation/etiology; Brain Ischemia; Heart Failure/complications; Humans; Postoperative Complications/epidemiology; Retrospective Studies; Risk Factors; Stroke/epidemiology; Thromboembolism/etiology; •; Surgical aortic valve replacement; Postoperative atrial fibrillation; Coronary artery bypass grafting; Cardiology and Cardiovascular Medicine; Pulmonary and Respiratory Medicine; Surgery |
URI: | https://hdl.handle.net/20.500.11815/4644 |
Citation:Rezk , M , Taha , A , Nielsen , S J , Martinsson , A , Bergfeldt , L , Guðbjartsson , T , Franzén , S & Jeppsson , A 2023 , ' Associations between new-onset postoperative atrial fibrillation and long-term outcome in patients undergoing surgical aortic valve replacement ' , European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery , vol. 63 , no. 5 , ezad103 . https://doi.org/10.1093/ejcts/ezad103
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Abstract:OBJECTIVES: Data on prognostic implications of new-onset postoperative atrial fibrillation (POAF) after surgical aortic valve replacement (SAVR) is limited. We sought to explore associations between POAF, early initiated oral anticoagulation (OAC) and long-term outcome after SAVR and combined SAVR + coronary artery bypass grafting (CABG). METHODS: This is a retrospective, population-based study including all isolated SAVR (n = 7038) and combined SAVR and CABG patients (n = 3854) without a history of preoperative atrial fibrillation (AF) in Sweden 2007-2017. Individual patient data were merged from 4 nationwide registries. Inverse probability of treatment weighting-adjusted Cox regression models were employed separately in SAVR and SAVR + CABG patients. The median follow-up time was 4.7 years (range 0-10 years). RESULTS: POAF occurred in 44.5% and 50.7% of SAVR and SAVR + CABG patients, respectively. In SAVR patients, POAF was associated with increased long-term risk of death [adjusted hazard ratio (aHR) 1.21 (95% confidence interval 1.06-1.37)], ischaemic stroke [aHR 1.32 (1.08-1.59)], any thromboembolism, heart failure hospitalization and recurrent AF. In SAVR + CABG, POAF was associated with death [aHR 1.31 (1.14-1.51)], recurrent AF and heart failure, but not with ischaemic stroke [aHR 1.04 (0.84-1.29)] or thromboembolism. OAC was dispensed within 30 days after discharge to 67.0% and 65.9%, respectively, of SAVR and SAVR + CABG patients with POAF. Early initiated OAC was not associated with reduced risk of death, ischaemic stroke or thromboembolism in any group of patients. CONCLUSIONS: POAF after SAVR is associated with an increased risk of long-term mortality and morbidity. Further studies are warranted to clarify the role of OAC in SAVR patients with POAF.
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Description:© The Author(s) 2023. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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