Risk Factors for Postoperative Atrial Fibrillation in Myocardial Revascularization Surgery: A 15-Year Experience
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Subjects and Design
2.2. Data Collection
2.3. Statistical Analysis
3. Results
4. Discussion
4.1. Clinical Implications of the Study
4.2. Study Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Audisio, K.; Halbreiner, M.S.; Chadow, D.; Gaudino, M. Radial artery or saphenous vein for coronary artery bypass grafting. Trends Cardiovasc. Med. 2022, 32, 479–484. [Google Scholar] [CrossRef] [PubMed]
- Lubitz, S.A.; Yin, X.; Rienstra, M.; Schnabel, R.B.; Walkey, A.J.; Magnani, J.W.; Rahman, F.; McManus, D.D.; Tadros, T.M.; Levy, D.; et al. Long-term outcomes of secondary atrial fibrillation in the community: The Framingham heart study. Circulation 2015, 131, 1648–1655. [Google Scholar] [CrossRef]
- Fernandez, F.G.; Shahian, D.M.; Kormos, R.; Jacobs, J.P.; D’Agostino, R.S.; Mayer, J.E., Jr.; Kozower, B.D.; Higgins, R.S.; Badhwar, V. The society of thoracic surgeons national database 2019 annual report. Ann. Thorac. Surg. 2019, 108, 1625–1632. [Google Scholar] [CrossRef] [PubMed]
- Omar, A.; Elshihy, E.M.; Singer, M.; Zarif, D.; Dawoud, O. Perioperative risk factors predisposing to atrial fibrillation after CABG surgery. Heart Surg. Forum 2021, 24, E402–E406. [Google Scholar] [CrossRef] [PubMed]
- Alkan Kayhan, S.; Güner, E.; Hanedan, M.O.; Topal Çolak, E.; Mataraci, İ. Relationship between preoperative anxiety and atrial fibrillation after coronary artery bypass graft surgery. J. Nurs. Res. 2022, 30, e187. [Google Scholar] [CrossRef] [PubMed]
- Ferreira, A.F.; Moreira, R.; Pinho, P. Postoperative atrial fibrillation after coronary artery bypass grafting surgery. Rev. Port. Cir. Cardiotorac. Vasc. 2017, 24, 129. [Google Scholar] [PubMed]
- Gaudino, M.; Di Franco, A.; Rong, L.Q.; Piccini, J.; Mack, M. Postoperative atrial fibrillation: From mechanisms to treatment. Eur. Heart J. 2023, 44, 1020–1039. [Google Scholar] [CrossRef] [PubMed]
- Melduni, R.M.; Schaff, H.V.; Bailey, K.R.; Cha, S.S.; Ammash, N.M.; Seward, J.B.; Gersh, B.J. Implications of new-onset atrial fibrillation after cardiac surgery on long-term prognosis: A community-based study. Am. Heart J. 2015, 170, 659–668. [Google Scholar] [CrossRef] [PubMed]
- Lee, S.H.; Kang, D.R.; Uhm, J.S.; Shim, J.; Sung, J.H.; Kim, J.Y.; Pak, H.N.; Lee, M.H.; Joung, B. New-onset atrial fibrillation predicts long-term newly developed atrial fibrillation after coronary artery bypass graft. Am. Heart J. 2014, 167, 593–600.e1. [Google Scholar] [CrossRef] [PubMed]
- Sihombing, R.S.; Muhadi, M.; Mansjoer, A.; Rinaldi, I. The influence of new-onset atrial fibrillation after coronary artery bypass grafting on three-year survival. Acta Med. Indones. 2020, 52, 125–130. [Google Scholar] [PubMed]
- Caldonazo, T.; Kirov, H.; Rahouma, M.; Robinson, N.B.; Demetres, M.; Gaudino, M.; Doenst, T.; Dobrev, D.; Borger, M.A.; Kiehntopf, M.; et al. Atrial fibrillation after cardiac surgery: A systematic review and meta-analysis. J. Thorac. Cardiovasc. Surg. 2023, 165, 94–103.e24. [Google Scholar] [CrossRef]
- Banach, M.; Rysz, J.; Drozdz, J.A.; Okonski, P.; Misztal, M.; Barylski, M.; Irzmanski, R.; Zaslonka, J. Risk factors of atrial fibrillation following coronary artery bypass grafting: A preliminary report. Circ. J. 2006, 70, 438–441. [Google Scholar] [CrossRef] [PubMed]
- Asociación Médica Mundial. Declaración de Helsinki. Principios Éticos Para las Investigaciones Médicas en Seres Humanos. 1964. Available online: https://www.wma.net/es/policies-post/declaracion-de-helsinki-de-la-amm-principios-eticos-para-las-investigaciones-medicas-en-seres-humanos/ (accessed on 14 June 2023). (In Spanish).
- Ministerio de Salud. Resolución 8430 de República de Colombia. 1993. Available online: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/RESOLUCION-8430-DE-1993.PDF (accessed on 14 June 2023). (In Spanish)
- January, C.T.; Wann, L.S.; Calkins, H.; Chen, L.Y.; Cigarroa, J.E.; Cleveland, J.C., Jr.; Ellinor, P.T.; Ezekowitz, M.D.; Field, M.E.; Furie, K.L.; et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the heart rhythm society. J. Am. Coll. Cardiol. 2019, 74, 104–132. [Google Scholar] [CrossRef]
- Stamou, S.C.; Dangas, G.; Hill, P.C.; Pfister, A.J.; Dullum, M.K.; Boyce, S.W.; Bafi, A.S.; Garcia, J.M.; Corso, P.J. Atrial fibrillation after beating heart surgery. Am. J. Cardiol. 2000, 86, 64–67. [Google Scholar] [CrossRef] [PubMed]
- Mostafa, A.; El-Haddad, M.A.; Shenoy, M.; Tuliani, T. Atrial fibrillation post cardiac bypass surgery. Avicenna J. Med. 2012, 2, 65–70. [Google Scholar] [CrossRef]
- Almassi, G.H.; Schowalter, T.; Nicolosi, A.C.; Aggarwal, A.; Moritz, T.E.; Henderson, W.G.; Tarazi, R.; Shroyer, A.L.; Sethi, G.K.; Grover, F.L.; et al. Atrial fibrillation after cardiac surgery: A major morbid event? Ann. Surg. 1997, 226, 501–511. [Google Scholar] [CrossRef] [PubMed]
- Villareal, R.P.; Hariharan, R.; Liu, B.C.; Kar, B.; Lee, V.V.; Elayda, M.; Lopez, J.A.; Rasekh, A.; Wilson, J.M.; Massumi, A. Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. J. Am. Coll. Cardiol. 2004, 43, 742–748. [Google Scholar] [CrossRef]
- Rajput, H.A.S.; Khan, F.; Zargar, U.Q.; Iqbal, F.; Shamim, K.; Wahab, A.; Khalid, I.; Siddiqui, Z.; Rajput, L.S.; Abbas, K. Association of atrial fibrillation with patient characteristics in postoperative coronary artery bypass grafting surgery. Cureus 2021, 13, e19800. [Google Scholar] [CrossRef]
- Hakala, T.; Pitkänen, O.; Hippeläinen, M. Feasibility of predicting the risk of atrial fibrillation after coronary artery bypass surgery with logistic regression model. Scand. J. Surg. 2002, 91, 339–344. [Google Scholar] [CrossRef]
- Silva, R.G.; Lima, G.G.; Laranjeira, A.; Costa, A.R.; Pereira, E.; Rodrigues, R. Risk factors, morbidity, and mortality associated with atrial fibrillation in the postoperative period of cardiac surgery. Arq. Bras. Cardiol. 2004, 83, 105–110. [Google Scholar]
- Seo, E.J.; Hong, J.; Lee, H.J.; Son, Y.J. Perioperative risk factors for new-onset postoperative atrial fibrillation after coronary artery bypass grafting: A systematic review. BMC. Cardiovasc. Disord. 2021, 21, 418. [Google Scholar] [CrossRef] [PubMed]
- Hu, Y.; Yang, X.; Zhang, L.; Wu, X.; Liu, A.Y.; Boscarino, J.A.; Kirchner, H.L.; Casale, A.S.; Zhang, X. Perioperative diltiazem or nitroglycerin in on-pump coronary artery bypass: A systematic review and network meta-analysis. PLoS ONE 2018, 13, e0203315. [Google Scholar] [CrossRef] [PubMed]
- Hajjar, L.A.; Vincent, J.L.; Barbosa Gomes Galas, F.R.; Rhodes, A.; Landoni, G.; Osawa, E.A.; Melo, R.R.; Sundin, M.R.; Grande, S.M.; Gaiotto, F.A.; et al. Vasopressin versus norepinephrine in patients with vasoplegic shock after cardiac surgery: The VANCS randomized controlled trial. Anesthesiology 2017, 126, 85–93. [Google Scholar] [CrossRef] [PubMed]
- Alexandrescu, D.M.; Costache, I.I. Acute cardiogenic pulmonary edema--etiological spectrum and precipitating factors. Rev. Med. Chir. Soc. Med. Nat. Iasi 2014, 118, 301–306. [Google Scholar] [PubMed]
- Vaska, K.; Wann, L.S.; Sagar, K.; Klopfenstein, H.S. Pleural effusion as a cause of right ventricular diastolic collapse. Circulation 1992, 86, 609–617. [Google Scholar] [CrossRef] [PubMed]
- Nishida, O.; Arellano, R.; Cheng, D.C.; DeMajo, W.; Kavanagh, B.P. Gas exchange and hemodynamics in experimental pleural effusion. Crit. Care Med. 1999, 27, 583–587. [Google Scholar] [CrossRef] [PubMed]
- Sadaniantz, A.; Anastacio, R.; Verma, V.; Aprahamian, N. The incidence of diastolic right atrial collapse in patients with pleural effusion in the absence of pericardial effusion. Echocardiography 2003, 20, 211–215. [Google Scholar] [CrossRef] [PubMed]
- Daza-Arana, J.E.; Lozada-Ramos, H.; Ávila-Hernández, D.F.; Ordoñez-Mora, L.T.; Sánchez, D.P. Prolonged mechanical ventilation following coronary artery bypass graft in Santiago De Cali, Colombia. Vasc. Health Risk Manag. 2022, 18, 767–781. [Google Scholar] [CrossRef] [PubMed]
- Liu, S.; Li, Z.; Liu, Z.; Hu, Z.; Zheng, G. Blood transfusion and risk of atrial fibrillation after coronary artery bypass graft surgery: A meta-analysis of cohort studies. Medicine 2018, 97, e9700. [Google Scholar] [CrossRef]
- Demal, T.J.; Fehr, S.; Mariscalco, G.; Reiter, B.; Bibiza, E.; Reichenspurner, H.; Gatti, G.; Onorati, F.; Faggian, G.; Salsano, A.; et al. Coronary artery bypass grafting in patients with high risk of bleeding. Heart Lung Circ. 2022, 31, 263–271. [Google Scholar] [CrossRef]
- Marmelo, F.; Rocha, V.; Moreira-Gonçalves, D. The impact of prehabilitation on post-surgical complications in patients undergoing non-urgent cardiovascular surgical intervention: Systematic review and meta-analysis. Eur. J. Prev. Cardiol. 2018, 25, 404–417. [Google Scholar] [CrossRef] [PubMed]
- Lozada-Ramos, H.; Daza-Arana, J.E.; Zárate González, M.; Medina Gallo, L.F.; Lanas, F. Risk factors for in-hospital mortality after coronary artery bypass grafting in Colombia. J. Cardiovasc. Surg. 2022, 63, 78–84. [Google Scholar] [CrossRef] [PubMed]
- Hu, Y.F.; Chen, Y.J.; Lin, Y.J.; Chen, S.A. Inflammation and the pathogenesis of atrial fibrillation. Nat. Rev. Cardiol. 2015, 12, 230–243. [Google Scholar] [CrossRef] [PubMed]
- Kaw, R.; Hernandez, A.V.; Masood, I.; Gillinov, A.M.; Saliba, W.; Blackstone, E.H. Short- and long-term mortality associated with new-onset atrial fibrillation after coronary artery bypass grafting: A systematic review and meta-analysis. J. Thorac. Cardiovasc. Surg. 2011, 141, 1305–1312. [Google Scholar] [CrossRef] [PubMed]
- Mariani, M.V.; Pierucci, N.; Trivigno, S.; Cipollone, P.; Piro, A.; Chimenti, C.; Della Rocca, D.G.; Miraldi, F.; Vizza, C.D.; Lavalle, C. Probability Score to Predict Spontaneous Conversion to Sinus Rhythm in Patients with Symptomatic Atrial Fibrillation When Less Could Be More? J. Clin. Med. 2024, 13, 1470. [Google Scholar] [CrossRef]
Variable | Cases AF n = 90 | Controls No AF n = 360 | Total n = 450 | p-Value |
---|---|---|---|---|
n (%) | n (%) | n (%) | ||
Age (years) | 0.001 | |||
<55 | 6 (6.7) | 43 (11.9) | 49 (10.9) | |
55–64 | 16 (17.8) | 130 (36.2) | 146 (32.4) | |
65–74 | 43 (47.8) | 120 (33.3) | 163 (36.2) | |
≥75 | 25 (27.8) | 67 (18.6) | 92 (20.4) | |
Average ± SD 1 | 69.6 ± 7.7 | 65.1 ± 9.3 | 66.0 ± 9.2 | 0.000 |
BMI (kg/m2) | 0.007 | |||
<25 | 48 (53.3) | 136 (37.8) | 184 (40.9) | |
25–29 | 32 (35.6) | 178 (49.4) | 210 (46.7) | |
30–34 | 6 (6.7) | 38 (10.6) | 44 (9.8) | |
≥35 | 4 (4.4) | 8 (2.2) | 12 (2.7) | |
Average ± SD 1 | 25.3 ± 4.1 | 26.0 ± 3.6 | 25.9 ± 3.7 | 0.106 |
Body surface (m2) | 0.420 | |||
<1.5 | 6 (6.7) | 21 (5.8) | 27 (6.0) | |
1.5–1.74 | 38 (42.2) | 137 (38.2) | 175 (38.9) | |
1.75–1.99 | 37 (41.1) | 165 (45.8) | 202 (44.9) | |
≥2.0 | 9 (10) | 37 (10.3) | 46 (10.2) | |
Average ± SD 1 | 1.8 ± 0.2 | 1.8 ± 0.2 | 1.8 ± 0.2 | 0.349 |
Sex | ||||
Female | 29 (32.2) | 99 (27.5) | 128 (28.4) | |
Male | 61 (67.8) | 261 (72.5) | 322 (71.6) | 0.374 |
Socioeconomic | ||||
Stratum | ||||
High | 4 (4.4) | 32 (8.9) | 36 (8.0) | |
Middle | 60 (66.7) | 222 (61.7) | 282 (62.7) | 0.164 |
Low | 26 (28.9) | 106(29.4) | 132 (29.3) | |
Smoker | ||||
No | 42 (46.7) | 168 (46.7) | 210 (46.7) | |
Yes 2 | 48 (53.3) | 192 (53.3) | 240 (53.3) | 1.00 |
Diabetes mellitus | ||||
No | 52 (57.8) | 218 (60.6) | 270 (60.0) | |
Insulin-dependent | 14 (15.6) | 61 (16.9) | 75 (16.7) | 0.403 |
Noninsulin-dependent | 24 (26.7) | 81 (22.5) | 105 (23.3) | |
Dyslipidemia | ||||
No | 36 (40) | 144 (40) | 180 (40) | |
Yes | 54 (60) | 216 (60) | 270 (60) | 1.00 |
Heart Failure | ||||
No | 61 (67.8) | 279 (77.5) | 340 (75.6) | |
Yes | 29 (32.2) | 81 (22.5) | 110 (24.4) | 0.055 |
LVEF | ||||
≥35% | 79 (87.8) | 332 (92.2) | 411 (91.3) | 0.180 |
<35% | 11 (12.2) | 28 (7.8) | 39 (8.7) | |
Average ± SD 1 | 50.7 ± 10.9 | 51.8 ± 9.9 | 51.5 ± 10.1 | 0.385 |
Arterial hypertension | ||||
No | 9 (10) | 37 (10.3) | 46 (10.2) | |
Yes | 81 (90) | 323 (89.7) | 404 (89.8) | 0.938 |
COPD: | ||||
No | 70 (77.8) | 321(89.2) | 391 (86.9) | 0.004 |
Yes | 20 (22.2) | 39(10.8) | 59 (13.1) | |
Sepsis | ||||
No | 81 (90) | 335 (93.1) | 416 (92.4) | 0.327 |
Yes | 9 (10) | 25 (6.9) | 34 (7.6) | |
Chronic kidney failure | ||||
No | 70 (77.8) | 318 (88.3) | 388 (86.2) | |
Without dialysis | 15 (16.7) | 32 (8.9) | 47 (10.4) | 0.009 |
With dialysis | 5 (5.6) | 10 (2.8) | 15 (3.3) | |
Renal function | 0.199 | |||
Creatinine level: <2.3 mg/dL | 83 (92.2) | 344 (95.6) | 427 (94.9) | |
Creatinine level: ≥2.3 mg/dL | 7 (7.8) | 16 (4.4) | 23 (5.1) | |
Average ± SD 1 | 1.3 ± 1.3 | 1.2 ± 1.1 | 1.2 ± 1.2 | 0.338 |
Peripheral vascular disease | ||||
No | 73 (81.1) | 324 (90) | 397 (88.2) | 0.019 |
Yes | 17 (18.9) | 36 (10) | 53 (11.8) | |
Pulmonary hypertension | ||||
No | 70 (77.8) | 310 (86.1) | 380 (84.4) | |
Mild-Moderate | 16 (17.8) | 43 (11.9) | 59 (13.1) | 0.051 |
Severe | 4 (4.4) | 7 (1.9) | 11 (2.4) | |
Stroke | ||||
No | 85 (94.4) | 349 (96.9) | 434 (96.5) | 0.252 |
Yes | 5 (5.6) | 11 (3.1) | 16 (3.6) | |
Arrhythmia | ||||
No | 86 (95.6) | 346 (96.1) | 432 (96.0) | 0.810 |
Yes | 4 (4.4) | 14 (3.9) | 18 (4.0) | |
Type of arrhythmia | ||||
Atrial fibrillation | 0 (0) | 0 (0) | 0 (0) | - |
Supraventricular tachycardia | 0 (0) | 6 (1.7) | 6 (1.3) | - |
Ventricular tachycardia | 0 (0) | 2 (0.6) | 2 (0.4) | - |
Ventricular fibrillation | 0 (0) | 2 (0.6) | 2 (0.4) | - |
Extrasystole | 2 (2.2) | 5 (1.4) | 7 (1.6) | 0.568 |
Other | 2 (2.2) | 0 (0) | 2 (0.4) | - |
AMI | ||||
No | 52 (57.8) | 193 (53.6) | 245 (54.4) | |
>21 days | 14 (15.6) | 57 (15.8) | 71 (15.8) | 0.478 |
8–21 days | 17 (18.9) | 80 (22.2) | 97 (21.6) | |
≤7 days | 7 (7.8) | 30 (8.3) | 37 (8.2) | |
Previous percutaneous intervention | ||||
No | 66 (73.3) | 287 (79.7) | 353 (78.4) | 0.187 |
Yes | 24 (26.7) | 73 (20.3) | 97 (21.6) | |
Use of IABP | ||||
No | 86 (95.6) | 351 (97.5) | 437 (91.2) | 0.325 |
Yes | 4 (4.4) | 9 (2.5) | 13 (2.9) | |
Angina: | ||||
No | 46 (51.1) | 211 (58.6) | 257 (57.1) | 0.198 |
Yes | 44 (48.9) | 149 (41.4) | 193 (42.9) | |
Hospital stay | ||||
≤7 days | 56 (62.2) | 261 (72.5) | 317 (70.4) | |
8–14 days | 31 (34.4) | 83 (23.1) | 114 (25.3) | 0.026 |
≥15 days | 3 (3.3) | 16 (4.4) | 19 (4.2) | |
Average ± SD 1 | 6.2 ± 4.9 | 5.9 ± 5.0 | 6.0 ± 4.9 | 0.540 |
Number of injured vessels | ||||
One vessel | 1 (1.1) | 23 (6.4) | 24 (5.3) | |
Two vessels | 16 (17.8) | 45 (12.5) | 61 (13.6) | 0.046 |
≥Three vessels | 73 (81.1) | 292 (81.1) | 365 (81.1) | |
Left main coronary artery lesion | ||||
No | 65 (72.2) | 290 (80.6) | 355 (78.9) | 0.083 |
Yes | 25 (27.8) | 70 (19.4) | 95 (21.1) | |
Hemoglobin: | ||||
≥12 g/dL | 58 (64.4) | 266 (73.9) | 324 (72) | 0.074 |
<12 g/dL | 32 (35.6) | 94 (26.2) | 126 (28) | |
Average ± SD 1 | 12.7 ± 1.9 | 13.1 ± 1.8 | 13.1 ± 1.8 | 0.057 |
Blood transfusion: 3 | ||||
No | 87 (96.7) | 351 (97.5) | 438 (97.3) | 0.661 |
Yes | 3 (3.3) | 9 (2.5) | 12 (2.7) | |
Type of surgery | ||||
Elective | 76 (84.4) | 338 (93.9) | 36 (8) | 0.003 |
Urgent/Emergency | 14 (15.6) | 22 (6.1) | 414 (92) | |
Use of vasodilators | ||||
No | 70 (77.8) | 295 (81.9) | 365 (81.1) | 0.366 |
Yes | 20 (22.2) | 65 (18.1) | 85 (18.9) | |
Use of vasopressors | ||||
No | 89 (98.9) | 356 (98.9) | 445 (98.9) | 1.00 |
Yes | 1 (1.1) | 4 (1.1) | 5 (1.1) | |
Use of inotropics | ||||
No | 89 (98.9) | 355 (98.6) | 444 (98.7) | 0.837 |
Yes | 1 (1.1) | 5 (1.4) | 6 (1.3) | |
Ventilatory support: | ||||
No | 84 (93.3) | 348 (96.7) | 432 (96.0) | 0.149 |
Yes | 6 (6.7) | 12 (3.3) | 18 (4.0) | |
Valve insufficiency | ||||
Aortic | ||||
Mild | 12 (13.3) | 30 (8.3) | 42 (9.3) | 0.145 |
Moderate | 3 (3.3) | 6 (1.7) | 9 (2.0) | |
Tricuspid | ||||
Mild | 13 (14.4) | 39 (10.8) | 52 (11.6) | |
Moderate | 0 (0) | 5 (1.4) | 5 (1.1) | 0.338 |
Severe | 1 (1.1) | 0 (0.) | 1 (0.2) | |
Mitral | ||||
Mild | 26 (28.9) | 99 (27.5) | 125 (27.8) | |
Moderate | 11 (12.2) | 14 (3.9) | 25 (5.6) | 0.002 |
Severe | 1 (1.1) | 0 (0) | 1 (0.2) | |
Valvular stenosis | ||||
Aortic | ||||
Yes | 3 (3.3) | 7 (1.9) | 10 (2.2) | 0.424 |
No | 87 (96.7) | 353 (98.1) | 440 (97.8) | |
Mitral | ||||
Yes | 2 (2.2) | 1 (0.3) | 3 (0.7) | 0.043 |
No | 88 (97.8) | 359 (99.7) | 447 (99.3) |
Variable | Cases AF n = 90 | Controls No AF n = 360 | Total n = 450 | p-Value |
---|---|---|---|---|
n (%) | n (%) | n (%) | ||
Revascularized vessels | ||||
<3 vessels | 12 (13.3) | 61 (16.9) | 73 (16.2) | 0.406 |
≥3 vessels | 78 (86.7) | 299 (83.1) | 377 (83.8) | |
Extracorporeal circulation | ||||
No | 1 (1.1) | 13 (3.6) | 14 (3.1) | |
Yes | 89 (98.9) | 347 (96.4) | 436 (96.9) | 0.222 |
Pump time | ||||
≤90 min | 72 (80) | 313 (86.9) | 385 (85.6) | 0.094 |
>90 min | 18 (20) | 47 (13.1) | 65 (14.4) | |
Average ± SD 1 | 76.9 ± 19.9 | 70.7 ± 23.1 | 71.9 ± 22.6 | 0.020 |
Ischemia time | ||||
<60 min | 73 (81.1) | 314 (87.2) | 387 (86.0) | 0.135 |
≥60 min | 17 (18.9) | 46 (12.8) | 63 (14.0) | |
Average ± SD 1 | 48.3 ± 14.2 | 44.3 ± 14.5 | 45.1 ± 14.5 | 0.020 |
Blood transfusion 2 | ||||
No | 29 (32.2) | 148 (41.1) | 177 (39.3) | |
Yes | 61 (67.8) | 212 (58.9) | 273 (60.7) | 0.123 |
Type of blood products | ||||
Red blood cells | ||||
≤3 units | 48 (53.3) | 171 (47.5) | 219 (48.7) | 0.322 |
>3 units | 11 (12.2) | 30 (8.3) | 41 (9.1) | |
Plasma | ||||
≤2 units | 29 (32.2) | 109 (30.3) | 138 (30.7) | 0.720 |
>2 units | 22 (24.4) | 73 (20.3) | 95 (21.1) | |
Platelets | ||||
≤6 units | 8 (8.9) | 18 (5) | 26 (5.8) | 0.157 |
>6 units | 5 (5.6) | 16 (4.4) | 21 (4.7) | |
Use of IABP | ||||
No | 80 (88.9) | 336 (93.3) | 416 (92.4) | 0.154 |
Yes | 10 (11.1) | 24 (6.7) | 34 (7.6) | |
Cardiogenic shock | ||||
No | 83 (92.2) | 344 (95.6) | 427 (94.9) | 0.199 |
Yes | 7 (7.8) | 16 (4.4) | 23 (5.1) | |
Arrhythmia | ||||
No | 87 (96.7) | 342 (95) | 429 (95.3) | 0.503 |
Yes | 3 (3.3) | 18 (5) | 21 (4.7) | |
Type of arrhythmia | ||||
Atrial fibrillation | 0 (0) | 0 (0) | 0 (0) | |
Supraventricular tachycardia | 0 (0) | 1 (0.3) | 1 (0.2) | |
Ventricular tachycardia | 1 (1.1) | 3 (0.8) | 4 (0.9) | 0.802 |
Ventricular fibrillation | 0 (0) | 8 (2.2) | 8 (1.8) | |
Other | 1 (1.1) | 0 (0) | 1 (0.2) | |
Use of vasopressors | ||||
No | 71 (78.) | 284 (78.9) | 355 (78.9) | 1.00 |
Yes | 19 (21.1) | 76 (21.1) | 95 (21.1) | |
Use of inotropics | ||||
No | 43 (47.8) | 187 (51.9) | 230 (51.1) | 0.479 |
Yes | 47 (52.2) | 173 (48.1) | 220 (48.9) | |
Use of vasodilators | ||||
No | 61 (67.8) | 240 (66.7) | 301 (66.9) | 0.841 |
Yes | 29 (32.2) | 120 (33.3) | 149 (33.1) |
Variable | Cases AF n = 90 | Controls No AF n = 360 | Total | p-Value |
---|---|---|---|---|
n (%) | n (%) | n (%) | ||
Intensive care stay | ||||
≤2 days | 8 (8.9) | 71 (19.7) | 79 (17.6) | |
>2 days | 82 (91.1) | 289 (80.3) | 371 (82.4) | 0.016 |
Hospital stay | ||||
Not admitted to hospital | 16 (17.8) | 31 (8.6) | 47 (10.4) | |
Admitted to hospital | 74 (82.2) | 329 (91.4) | 403 (89.6) | 0.011 |
Blood transfusion 2 | ||||
No | 38 (42.2) | 237 (65.8) | 275 (61.1) | |
Yes | 52 (57.8) | 123 (34.2) | 175 (38.9) | 0.000 |
Type of blood products | ||||
Red blood cells | ||||
≤3 units | 32 (35.6) | 84 (23.3) | 116 (25.8) | |
>3 units | 15 (16.7) | 27 (7.5) | 42 (9.3) | 0.007 |
Plasma | ||||
≤2 units | 4 (4.4) | 4 (1.1) | 8 (1.8) | 0.032 |
>2 units | 16 (17.8) | 41 (11.4) | 57 (12.7) | |
Platelets | ||||
≤6 units | 5 (5.6) | 12 (3.3) | 17 (3.8) | 0.323 |
>6 units | 2 (2.2) | 5 (1.4) | 7 (1.6) | |
Cryoprecipitate | ||||
<10 units | 2 (2.2) | 9 (2.5) | 11 (2.4) | 0.879 |
≥10 units | 2 (2.2) | 2 (0.6) | 4 (0.9) | |
Use of vasopressors | ||||
No | 50 (55.6) | 260 (72.2) | 310 (68.9) | |
Yes | 40 (44.4) | 100 (27.8) | 140 (31.1) | 0.002 |
Use of inotropics | ||||
No | 22 (24.4) | 150 (41.7) | 172 (38.2) | |
Yes | 68 (75.6) | 210 (58.3) | 278 (61.8) | 0.003 |
Use of vasodilators | ||||
No | 39 (43.3) | 200 (55.6) | 239 (53.1) | |
Yes | 51 (56.7) | 160 (44.4) | 211 (46.9) | 0.038 |
Use of IABP | ||||
No | 80 (88.9) | 335 (93.1) | 415 (92.2) | |
Yes | 10 (11.1) | 25 (6.9) | 35 (7.8) | 0.187 |
Cardiogenic shock | ||||
No | 66 (73.3) | 326 (90.6) | 392 (87.1) | |
Yes | 24 (26.7) | 34 (9.4) | 58 (12.9) | 0.000 |
SvO2 | ||||
≥60% | 68 (75.6) | 315 (87.5) | 383 (85.1) | 0.004 |
<60% | 22 (24.4) | 45 (12.5) | 67 (14.9) | |
Average ± SD 1 | 65.4 ± 10.1 | 68.8 ± 8.3 | 68.2 ± 8.8 | 0.001 |
Invasive mechanical ventilation time | ||||
≤2 days | 56 (62.2) | 310 (86.1) | 366 (81.3) | |
>2 days | 34 (37.8) | 50 (13.9) | 84 (18.7) | 0.000 |
Cardiorespiratory Complications | ||||
Pulmonary edema | 18 (20) | 12 (3.3) | 30 (6.7) | 0.000 |
AMI | 1 (1.1) | 3 (0.8) | 4 (0.9) | 0.802 |
ARDS | 3 (3.3) | 1 (0.3) | 4 (0.9) | 0.006 |
Hemothorax | 4 (4.4) | 5 (1,4) | 9 (2) | 0.064 |
Pneumothorax | 3 (3.3) | 0 (0) | 3 (0.7) | - |
Pleural effusion requiring drainage | 29 (32.2) | 36 (10) | 65 (14.4) | 0.000 |
Tracheal reintubation | 15 (16.7) | 15 (4.2) | 30 (6.7) | 0.000 |
Tracheostomy | 4 (4.4) | 5 (1.4) | 9 (2) | 0.064 |
Postsurgical bleeding | 14 (15.6) | 34 (9.4) | 48 (10.7) | 0.093 |
VAP | 3 (3.3) | 7 (1.9) | 10 (2.2) | 0.424 |
Surgical reintervention | 18 (20) | 45 (12.5) | 63 (14) | 0.067 |
Atelectasis | 16 (17.8) | 45 (12.5) | 61 (13.6) | 0.191 |
Neurological complications | ||||
Ischemic stroke | 6 (6.7) | 1 (0.3) | 7 (1.6) | 0.000 |
Delirium | 18 (20) | 32 (8.9) | 50 (11.1) | 0.003 |
TIA | 0 (0) | 1 (0.3) | 1 (0.2) | - |
Gastrointestinal complications | ||||
Intestinal bleeding | 4 (4.4) | 5 (1.4) | 9 (2) | 0.064 |
Infectious complications | ||||
Sepsis | 26 (28.9) | 54 (15) | 80 (17.8) | 0.002 |
Mediastinitis | 7 (7.8) | 13 (3,6) | 20 (4.4) | 0.086 |
Surgical site infection | 15 (16.7) | 33 (9.2) | 48 (10.7) | 0.039 |
Kidney complications | ||||
Kidney failure without dialysis | 8 (8.9) | 15 (4.2) | 23 (5.1) | |
Kidney failure with dialysis | 10 (11.1) | 8 (2.2) | 18 (4) | 0.000 |
Hematological complications: | ||||
Coagulopathy | 10 (11.1) | 9 (2.5) | 9 (4.2) | 0.000 |
Variable | Sodium (mEq/L) | Potassium (mEq/L) | Chlorine (mEq/L) | Magnesium (mg/dL) | Calcium (mg/dL) | Day of AF |
---|---|---|---|---|---|---|
Average | 140.2 | 4.2 | 105.8 | 2.8 | 1.1 | 2.3 |
Standard deviation | 4.8 | 0.8 | 5.1 | 0.6 | 0.3 | 1.5 |
Q1 (25%) | 137.2 | 3.7 | 102.0 | 2.4 | 1.0 | 1.0 |
Q2 (50%) | 140.0 | 4.1 | 106.0 | 2.9 | 1.0 | 2.0 |
Q3 (75%) | 143.0 | 4.4 | 109.0 | 3.2 | 1.1 | 3.0 |
Maximum | 150.0 | 6.9 | 117.0 | 3.8 | 3.0 | 7.0 |
Minimum | 128.0 | 2.6 | 93.3 | 1.5 | 0.8 | 1.0 |
Day and Cause of Death in Cases (n = 14) | |||||||
---|---|---|---|---|---|---|---|
Day of Death | n | % | Cause of Death | n | % | Average ± SD 1 | Median |
≤2 days | 6 | 42.8% | Sepsis | 6 | 42.8% | 19.5 days ± 10.8 | 20 days |
>2 days | 8 | 57.2% | Cardiogenic shock | ||||
Average: 10.7 days ± 10.7 1 | 8 | 57.2% | 4.1 days ± 10.7 | 2 days | |||
Median: 6 days | |||||||
Day and Cause of Death in Controls (n = 34) | |||||||
Day of death | n | % | Cause of death | n | % | Average ± SD 1 | Median |
≤2 days | 23 | 67% | Sepsis | 7 | 20.6% | 22.4 days ± 9.9 | 30 days |
>2 days | 11 | 33% | Bleeding | 6 | 17.7% | 1.33 days ± 9.1 | 1 day |
Average: 6 days ± 9.9 1 | Cardiogenic shock | 20 | 58.8% | 1.65 days ± 8.6 | 1 day | ||
Median: 2 days | AMI | 1 | 2.9% | 9 days ± 0.0 | 9 days |
Variable | Adjusted OR | 95% CI | p-Value |
---|---|---|---|
Age ≥60 years | 4.1 | 1.82–9.36 | 0.001 |
Urgent/emergency surgery | 2.1 | 1.06–4.85 | 0.044 |
Postsurgical cardiogenic shock | 2.5 | 1.28–4.77 | 0.007 |
Postsurgical blood transfusion | 1.6 | 1.26–2.78 | 0.030 |
Postsurgical pulmonary edema | 5.4 | 2.26–12.84 | 0.000 |
Postsurgical pleural effusion | 3.0 | 1.57–5.54 | 0.001 |
Retracheal intubation | 3.1 | 1.24–7.51 | 0.015 |
Mechanical ventilation time | 1.2 | 1.07–2.31 | 0.025 |
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© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Bonilla-Bonilla, D.M.; Osorio-Toro, L.M.; Daza-Arana, J.E.; Quintana-Ospina, J.H.; Ávila-Valencia, J.C.; Lozada-Ramos, H. Risk Factors for Postoperative Atrial Fibrillation in Myocardial Revascularization Surgery: A 15-Year Experience. J. Clin. Med. 2024, 13, 5171. https://doi.org/10.3390/jcm13175171
Bonilla-Bonilla DM, Osorio-Toro LM, Daza-Arana JE, Quintana-Ospina JH, Ávila-Valencia JC, Lozada-Ramos H. Risk Factors for Postoperative Atrial Fibrillation in Myocardial Revascularization Surgery: A 15-Year Experience. Journal of Clinical Medicine. 2024; 13(17):5171. https://doi.org/10.3390/jcm13175171
Chicago/Turabian StyleBonilla-Bonilla, Diana Marcela, Luis Miguel Osorio-Toro, Jorge Enrique Daza-Arana, Jhon H. Quintana-Ospina, Juan Carlos Ávila-Valencia, and Heiler Lozada-Ramos. 2024. "Risk Factors for Postoperative Atrial Fibrillation in Myocardial Revascularization Surgery: A 15-Year Experience" Journal of Clinical Medicine 13, no. 17: 5171. https://doi.org/10.3390/jcm13175171