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Eligulashvili A, Gordon M, Lee JS, Lee J, Mehrotra-Varma S, Mehrotra-Varma J, Hsu K, Hilliard I, Lee K, Li A, Essibayi MA, Yee J, Altschul DJ, Eskandar E, Mehler MF, Duong TQ. Long-term outcomes of hospitalized patients with SARS-CoV-2/COVID-19 with and without neurological involvement: 3-year follow-up assessment. PLoS Med 2024; 21:e1004263. [PMID: 38573873 PMCID: PMC10994395 DOI: 10.1371/journal.pmed.1004263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 02/28/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Acute neurological manifestation is a common complication of acute Coronavirus Disease 2019 (COVID-19) disease. This retrospective cohort study investigated the 3-year outcomes of patients with and without significant neurological manifestations during initial COVID-19 hospitalization. METHODS AND FINDINGS Patients hospitalized for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection between 03/01/2020 and 4/16/2020 in the Montefiore Health System in the Bronx, an epicenter of the early pandemic, were included. Follow-up data was captured up to 01/23/2023 (3 years post-COVID-19). This cohort consisted of 414 patients with COVID-19 with significant neurological manifestations and 1,199 propensity-matched patients (for age and COVID-19 severity score) with COVID-19 without neurological manifestations. Neurological involvement during the acute phase included acute stroke, new or recrudescent seizures, anatomic brain lesions, presence of altered mentation with evidence for impaired cognition or arousal, and neuro-COVID-19 complex (headache, anosmia, ageusia, chemesthesis, vertigo, presyncope, paresthesias, cranial nerve abnormalities, ataxia, dysautonomia, and skeletal muscle injury with normal orientation and arousal signs). There were no significant group differences in female sex composition (44.93% versus 48.21%, p = 0.249), ICU and IMV status, white, not Hispanic (6.52% versus 7.84%, p = 0.380), and Hispanic (33.57% versus 38.20%, p = 0.093), except black non-Hispanic (42.51% versus 36.03%, p = 0.019). Primary outcomes were mortality, stroke, heart attack, major adverse cardiovascular events (MACE), reinfection, and hospital readmission post-discharge. Secondary outcomes were neuroimaging findings (hemorrhage, active and prior stroke, mass effect, microhemorrhages, white matter changes, microvascular disease (MVD), and volume loss). More patients in the neurological cohort were discharged to acute rehabilitation (10.39% versus 3.34%, p < 0.001) or skilled nursing facilities (35.75% versus 25.35%, p < 0.001) and fewer to home (50.24% versus 66.64%, p < 0.001) than matched controls. Incidence of readmission for any reason (65.70% versus 60.72%, p = 0.036), stroke (6.28% versus 2.34%, p < 0.001), and MACE (20.53% versus 16.51%, p = 0.032) was higher in the neurological cohort post-discharge. Per Kaplan-Meier univariate survival curve analysis, such patients in the neurological cohort were more likely to die post-discharge compared to controls (hazard ratio: 2.346, (95% confidence interval (CI) [1.586, 3.470]; p < 0.001)). Across both cohorts, the major causes of death post-discharge were heart disease (13.79% neurological, 15.38% control), sepsis (8.63%, 17.58%), influenza and pneumonia (13.79%, 9.89%), COVID-19 (10.34%, 7.69%), and acute respiratory distress syndrome (ARDS) (10.34%, 6.59%). Factors associated with mortality after leaving the hospital involved the neurological cohort (odds ratio (OR): 1.802 (95% CI [1.237, 2.608]; p = 0.002)), discharge disposition (OR: 1.508 (95% CI [1.276, 1.775]; p < 0.001)), congestive heart failure (OR: 2.281 (95% CI [1.429, 3.593]; p < 0.001)), higher COVID-19 severity score (OR: 1.177 (95% CI [1.062, 1.304]; p = 0.002)), and older age (OR: 1.027 (95% CI [1.010, 1.044]; p = 0.002)). There were no group differences in radiological findings, except that the neurological cohort showed significantly more age-adjusted brain volume loss (p = 0.045) than controls. The study's patient cohort was limited to patients infected with COVID-19 during the first wave of the pandemic, when hospitals were overburdened, vaccines were not yet available, and treatments were limited. Patient profiles might differ when interrogating subsequent waves. CONCLUSIONS Patients with COVID-19 with neurological manifestations had worse long-term outcomes compared to matched controls. These findings raise awareness and the need for closer monitoring and timely interventions for patients with COVID-19 with neurological manifestations, as their disease course involving initial neurological manifestations is associated with enhanced morbidity and mortality.
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Affiliation(s)
- Anna Eligulashvili
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Moshe Gordon
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Jimmy S. Lee
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Jeylin Lee
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Shiv Mehrotra-Varma
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Jai Mehrotra-Varma
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Kevin Hsu
- Department of Radiology, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Imanyah Hilliard
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Kristen Lee
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Arleen Li
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Muhammed Amir Essibayi
- Department of Neurological Surgery, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Judy Yee
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - David J. Altschul
- Department of Neurological Surgery, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Emad Eskandar
- Department of Neurological Surgery, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Mark F. Mehler
- Department of Neurology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Tim Q. Duong
- Department of Radiology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, New York, United States of America
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Nikolaou M, Pattakos G, Hitas C, Koniari K, Pitsis A, Iliopoulos D, Xintarakou Α, Vardas EP, Pattakos S, Tzeis S, Vardas P. Atrial fibrillation post CABG and the risk of arrhythmia recurrence: the AFRODITE study. Hellenic J Cardiol 2024:S1109-9666(24)00058-7. [PMID: 38453014 DOI: 10.1016/j.hjc.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/25/2024] [Accepted: 03/03/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND New-onset postoperative atrial fibrillation (POAF) after coronary artery bypass surgery (CABG) occurs with an incidence of 20-40%. The clinical relevance of POAF remains a concern, and the need for further studies regarding the clinical management of POAF is necessary. AIM The AFRODITE study, a prospective multicenter cohort study, had as its primary endpoint the evaluation of AF recurrence in patients post CABG over a one-year period. METHODS Two hundred twenty-eight patients aged >50 years who underwent isolated CABG were included in the study. Patients were stratified into two groups, POAF and non-POAF, and followed for 12 months for AF recurrence, hospitalizations, and death. RESULTS Two hundred twenty-eight patients (mean age 67 years, 88.6% male) were included in the study. 28.5% of patients experienced at least one episode of POAF during index hospitalization (POAF group) and were compared with the non-POAF group (n = 163). Multivariate stepwise logistic regression analysis showed that the strongest prognostic parameter for POAF was the CHA2DS2-VASc score (odds ratio = 1.61, p < 0.001). POAF patients had a worse in-hospital outcome, but the incidence of long-term AF recurrence was not statistically different (3.6% vs. 4.8%, p = 0.9). CONCLUSION Interestingly, a one-year prospective follow-up of patients in the study did not reveal significant differences between POAF and non-POAF patients. A notable finding was that patients with a higher CHA2DS2-VASc score were more likely to develop POAF.
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Affiliation(s)
- Maria Nikolaou
- Cardiology Department, Amalia Fleming General Hospital, Melissia, Attiki, Greece.
| | - Gregory Pattakos
- Second Department of Cardiac Surgery and Division of Transcatheter Heart Valves, HYGEIA Hospital, Athens, Greece.
| | - Christos Hitas
- Cardiology Department, Amalia Fleming General Hospital, Melissia, Attiki, Greece.
| | - Katerina Koniari
- Sixth Department of Cardiology, Hygeia Group Hospitals, Athens, Greece.
| | - Antoniοs Pitsis
- First Department of Cardiac Surgery, European Interbalkan Medical Center, Greece.
| | - Dimitrios Iliopoulos
- Fourth Department of Cardiac Surgery, Hygeia Hospital, Maroussi, Attiki, Greece.
| | - Αnastasia Xintarakou
- First Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens, Greece.
| | - Emmanouil P Vardas
- Department of Cardiology, "G. Gennimatas" Athens General Hospital, Athens, Greece.
| | - Stratis Pattakos
- Second Department of Cardiac Surgery and Division of Transcatheter Heart Valves, HYGEIA Hospital, Athens, Greece.
| | - Stylianos Tzeis
- Cardiology Department, Mitera Hospital, Hygeia Group, Athens, Greece.
| | - Panagiotis Vardas
- Head of Heart Sector, Hygeia Group Hospitals, Hellenic Health Group, Athens, Greece.
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3
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Skojec AJ, Christensen JM, Yalamuri SM, Smith MM, Arghami A, LeMahieu AM, Schroeder DR, Mauermann WJ, Nuttall GA, Ritter MJ. Deep Parasternal Intercostal Plane Block for Postoperative Analgesia After Sternotomy for Cardiac Surgery-A Retrospective Cohort Study. J Cardiothorac Vasc Anesth 2024; 38:189-196. [PMID: 37968198 DOI: 10.1053/j.jvca.2023.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/31/2023] [Accepted: 09/29/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVE To examine the analgesic efficacy of postoperative deep parasternal intercostal plane (DPIP) blocks for patients having cardiac surgery via median sternotomy. DESIGN This single-center retrospective study compared patients receiving bilateral DPIP blocks with a matched cohort of patients not receiving DPIP blocks. SETTING Large quaternary referral center. PARTICIPANTS Adult patients admitted to the authors' institution from January 1, 2016, to August 14, 2020, for elective cardiac surgery via median sternotomy. INTERVENTIONS Patients received ultrasound-guided bilateral DPIP blocks. MEASUREMENTS AND MAIN RESULTS A total of 113 patients received a DPIP block; 3,461 patients did not. The estimated multiplicative change in cumulative opioid consumption through 24 hours was 0.42 (95% CI 0.32-0.56; p < 0.001), indicating that patients receiving DPIP blocks required 60% fewer opioids than patients who did not. Proportional odds ratios for the average pain score on postoperative day (POD) 0 was 0.46 (95% CI 0.32-0.65; p < 0.001), and POD 1 was 0.67 (95% CI 0.47-0.94; p = 0.021), indicating lower pain scores for patients receiving blocks. The exploratory analysis identified an inverse correlation between DPIP blocks and atrial fibrillation incidence (2% v 15%; inverse probability of treatment weighting odds ratio 0.088, 95% CI 0.02-0.41; p = 0.002). CONCLUSIONS The use of DPIP blocks in patients undergoing cardiac surgery via median sternotomy was associated with less opioid use and improved pain scores in the early postoperative period compared with patients not receiving blocks. Prospective randomized controlled studies should further elucidate the efficacy and risks of DPIP blocks in cardiac surgery.
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Affiliation(s)
- Alexander J Skojec
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesia, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Jon M Christensen
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesia, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Suraj M Yalamuri
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesia, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Mark M Smith
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesia, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Allison M LeMahieu
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Darrell R Schroeder
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - William J Mauermann
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesia, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Gregory A Nuttall
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesia, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Matthew J Ritter
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesia, Mayo Clinic College of Medicine and Science, Rochester, MN.
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Gerçek M, Börgermann J, Gummert J, Gerçek M. Five-year-outcome of new-onset perioperative atrial fibrillation after left atrial appendage amputation concomitant with cardiac surgery. Clin Res Cardiol 2023; 112:1800-1811. [PMID: 37428220 PMCID: PMC10698101 DOI: 10.1007/s00392-023-02255-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/21/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Recent data demonstrated the benefit of left atrial appendage (LAA)-amputation in patients with atrial fibrillation (AF). However, the long-term impact of LAA-amputation for patients with new-onset perioperative atrial fibrillation (POAF) is still unknown. METHODS Patients with no history of AF undergoing coronary artery bypass grafting by off-pump technique (OPCAB) between 2014 and 2016 were retrospectively examined. Cohorts were divided by the concomitant execution of LAA-amputation. Propensity score (PS) matching was applied by all available baseline characteristics. The composite of all-cause mortality, stroke and rehospitalization in patients with POAF and patients maintaining sinus rhythm posed as the primary endpoint. RESULTS A total of 1522 patients were enrolled, of whom 1208 and 243 were included in the control and the LAA-amputation group, respectively and were matched to 243 patients in each group. In total, patients with POAF without LAA-amputation showed a significantly higher rate of the composite endpoint (17.3% vs 32.1%, p = 0.007). However, patients with LAA-amputation showed no significant difference in the composite endpoint (23.2% vs 26.7%, p = 0.57). The significantly higher occurrence of the composite endpoint was driven by all-cause mortality (p = 0.005) and rehospitalization (p = 0.029). Subgroup analysis revealed a CHA2DS2-VASc-score of ≥ 3 to be associated with the high rate of the primary endpoint (p = 0.004). CONCLUSION POAF is associated with a higher rate of the combined endpoint of all-cause mortality, stroke and rehospitalization. The composite endpoint in patients with LAA-amputation concomitant with OPCAB surgery developing new-onset POAF in a 5-year follow-up was not increased compared to a control cohort maintaining sinus rhythm. Five-year outcome of patients with POAF and LAA-amputation; 95% CI, 95% confidence interval, CPR, cardiopulmonary resuscitation, ECLS, extracorporeal life support, HR, hazard ratio, IABP, intra-aortic balloon pump, LAA, left atrial appendage, OPCAB, off-pump coronary artery bypass grafting, PAPs, systolic pulmonary artery pressure, SR, sinus rhythm, VT, ventricular tachycardia.
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Affiliation(s)
- Mustafa Gerçek
- Heart Center Duisburg, Clinic for Cardiac Surgery and Pediatric Cardiac Surgery, Gerrickstraße 21, 47137, Duisburg, Germany
| | - Jochen Börgermann
- Heart Center Duisburg, Clinic for Cardiac Surgery and Pediatric Cardiac Surgery, Gerrickstraße 21, 47137, Duisburg, Germany
| | - Jan Gummert
- Herz- und Diabeteszentrum NRW, Clinic for Thoracic and Cardiovascular Surgery, Georgstraße 11, 32545, Bad Oeynhausen, Germany
| | - Muhammed Gerçek
- Herz- und Diabeteszentrum NRW, Clinic for General and Interventional Cardiology/Angiology, Georgstraße 11, 32545, Bad Oeynhausen, Germany.
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5
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Madsen CL, Park-Hansen J, Irmukhamedov A, Carranza CL, Rafiq S, Rodriguez-Lecoq R, Palmer-Camino N, Modrau IS, Hansson EC, Jeppsson A, Hadad R, Moya-Mitjans A, Greve AM, Christensen R, Carstensen HG, Høst NB, Dixen U, Torp-Pedersen C, Køber L, Gögenur I, Truelsen TC, Kruuse C, Sajadieh A, Domínguez H. The left atrial appendage closure by surgery-2 (LAACS-2) trial protocol rationale and design of a randomized multicenter trial investigating if left atrial appendage closure prevents stroke in patients undergoing open-heart surgery irrespective of preoperative atrial fibrillation status and stroke risk. Am Heart J 2023; 264:133-142. [PMID: 37302738 DOI: 10.1016/j.ahj.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/20/2023] [Accepted: 06/05/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Current recommendations regarding the use of surgical left atrial appendage (LAA) closure to prevent thromboembolisms lack high-level evidence. Patients undergoing open-heart surgery often have several cardiovascular risk factors and a high occurrence of postoperative atrial fibrillation (AF)-with a high recurrence rate-and are thus at a high risk of stroke. Therefore, we hypothesized that concomitant LAA closure during open-heart surgery will reduce mid-term risk of stroke independently of preoperative AF status and CHA2DS2-VASc score. METHODS This protocol describes a randomized multicenter trial. Consecutive participants ≥18 years scheduled for first-time planned open-heart surgery from cardiac surgery centers in Denmark, Spain, and Sweden are included. Both patients with a previous diagnosis of paroxysmal or chronic AF, as well as those without AF, are eligible to participate, irrespective of their CHA2DS2-VASc score. Patients already planned for ablation or LAA closure during surgery, with current endocarditis, or where follow-up is not possible are considered noneligible. Patients are stratified by site, surgery type, and preoperative or planned oral anticoagulation treatment. Subsequently, patients are randomized 1:1 to either concomitant LAA closure or standard care (ie, open LAA). The primary outcome is stroke, including transient ischemic attack, as assigned by 2 independent neurologists blinded to the treatment allocation. To recognize a 60% relative risk reduction of the primary outcome with LAA closure, 1,500 patients are randomized and followed for 2 years (significance level of 0.05 and power of 90%). CONCLUSIONS The LAACS-2 trial is likely to impact the LAA closure approach in most patients undergoing open-heart surgery. TRIAL REGISTRATION NCT03724318.
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Affiliation(s)
- Christoffer Læssøe Madsen
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Biomedical Science, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Park-Hansen
- Department of Cardiology, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Akhmadjon Irmukhamedov
- Department of Heart, Lung, and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Christian Lildal Carranza
- Department of Cardio-Thoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Sulman Rafiq
- Department of Cardio-Thoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Ivy Susanne Modrau
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Denmark; Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Emma C Hansson
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rakin Hadad
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | | | - Anders Møller Greve
- Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Clinical Research, Research Unit of Rheumatology, University of Southern Denmark, Odense University Hospital, Denmark
| | - Helle Gervig Carstensen
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Nis Baun Høst
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Ulrik Dixen
- Department of Cardiology, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | | | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ismail Gögenur
- Department of Surgery, Zealand University Hospital, Køge, Denmark
| | - Thomas Clement Truelsen
- Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christina Kruuse
- Department of Neurology, Neurovascular Research Unit, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
| | - Ahmad Sajadieh
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Helena Domínguez
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Biomedical Science, University of Copenhagen, Copenhagen, Denmark.
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Bianco V, Kilic A, Yousef S, Serna-Gallegos D, Aranda-Michel E, Wang Y, Thoma F, Navid F, Sultan I. The long-term impact of postoperative atrial fibrillation after cardiac surgery. J Thorac Cardiovasc Surg 2023; 166:1073-1083.e10. [PMID: 35248360 DOI: 10.1016/j.jtcvs.2021.10.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The literature has reported worse in-hospital outcomes for patients with atrial fibrillation. The objective of the following study is to provide detailed results on the long-term impact of postoperative atrial fibrillation on survival and hospital readmission in cardiac surgery. METHODS All patients undergoing open cardiac surgery were reviewed with the exclusion of preoperative atrial fibrillation or patients undergoing ventricular assist device, transplant, or Cox-Maze procedures. Propensity matching (1:1) was performed to ensure similar baseline characteristics. Multivariable analysis identified significant associations with mortality and readmission. RESULTS A total of 12,227 patients with cardiac disease were divided into 7927 patients (64.8%) without postoperative atrial fibrillation and 4300 patients (35.2%) with new-onset postoperative atrial fibrillation. Propensity matching (1:1) yielded 4275 risk-adjusted pairs. There was no difference between the nonpostoperative atrial fibrillation versus postoperative atrial fibrillation cohorts regarding operative mortality (4.61% vs 4.12%; P = .26) and stroke (2.32% vs 2.76%; P = .191). Patients with postoperative atrial fibrillation had higher rates of reoperation (12.12% vs 6.83%; P < .001), transfusion (43.42% vs 36.94%; P < .001), sepsis (1.99% vs 0.80%; P < .001), prolonged ventilation (15.88% vs 9.24% vs; P < .001), pneumonia (6.60% vs 2.36%; P < .001), renal failure (6.90% vs 3.37%; P < .001), and dialysis (4.94% vs 2.08%; P < .001). The postoperative atrial fibrillation cohort had a significantly higher incidence of atrial fibrillation on follow-up (11.74% vs 4.75%; P < .001). Postoperative atrial fibrillation was independently associated with mortality (hazard ratio, 1.21; 1.12-1.33; P < .001), all-cause readmissions (hazard ratio, 1.05; 1.01-1.1; P = .010), and heart failure-specific readmission (hazard ratio, 1.14; 1.04-1.26; P = .01). CONCLUSIONS Patients in the postoperative atrial fibrillation cohort had worse perioperative morbidity, lower survival, and more readmissions for heart failure on long-term follow-up.
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Affiliation(s)
- Valentino Bianco
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Arman Kilic
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Sarah Yousef
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Edgar Aranda-Michel
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Yisi Wang
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Floyd Thoma
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Forozan Navid
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
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7
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Dehmer GJ, Grines CL, Bakaeen FG, Beasley DL, Beckie TM, Boyd J, Cigarroa JE, Das SR, Diekemper RL, Frampton J, Hess CN, Ijioma N, Lawton JS, Shah B, Sutton NR. 2023 AHA/ACC Clinical Performance and Quality Measures for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Performance Measures. J Am Coll Cardiol 2023; 82:1131-1174. [PMID: 37516946 DOI: 10.1016/j.jacc.2023.03.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
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8
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Fu W, Green C, Wagner C, Pawar G, Ceniza N, Gupta R, Ghita C, Bologna M, Ahmetovic D, Ravi T, Proebstle J, Addrow V, Romano M, Ailawadi G, Bolling SF. Postoperative atrial fibrillation in mitral valve surgery is not benign. J Thorac Cardiovasc Surg 2023:S0022-5223(23)00785-7. [PMID: 37709167 DOI: 10.1016/j.jtcvs.2023.08.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/17/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE Postoperative atrial fibrillation (POAF) is common after cardiac surgery and is often considered to be benign despite recent data suggesting worse outcomes. There are no guidelines for the amount of POAF that triggers anticoagulation or for postoperative surveillance. We examined the rate of POAF, incidence of neurologic events, development of permanent atrial fibrillation, and mortality in patients undergoing isolated mitral valve surgery at a Mitral Foundation reference center. METHODS This is a retrospective cohort study of 922 adult patients from 2011 to 2022 with no preoperative history of arrhythmias. Multivariable logistic regression was used to identify independent risk factors for the primary outcomes. Kaplan-Meier analysis and Cox proportional-hazards model were used to characterize long-term survival. RESULTS The incidence of POAF was 39%. Median follow-up was 4.9 months (interquartile range, 1.1-42.6 months). Diabetes (odds ratio [OR], 2.2; 95% CI, 1.2-4.1; P = .01) and increasing age (OR, 1.1; 95% CI, 1.0-1.1; P < .001) were risk factors for POAF, whereas New York Heart Association functional class was not. POAF was a risk factor for the development of permanent atrial fibrillation (OR, 3.2; 95% CI 1.9-5.4; P < .001), which was associated with increased risk of neurologic events (OR, 3.8; 95% CI, 1.5-9.7; P = .004). Ultimately, patients with POAF had worse unadjusted (P < .001) and adjusted long-term mortality (hazard ratio, 1.8; 95% CI, 1.1-3.1; P = .03). CONCLUSIONS POAF is associated with an increased rate of neurologic events, portends development of permanent atrial fibrillation, and is associated with worse long-term survival. POAF is not benign and carries a long-term mortality implication.
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Affiliation(s)
- Whitney Fu
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich.
| | - China Green
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Catherine Wagner
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Gurnoordeep Pawar
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Nicolas Ceniza
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Rhea Gupta
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Corina Ghita
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Marco Bologna
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Dani Ahmetovic
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Tanvi Ravi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Jack Proebstle
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Vivica Addrow
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Matthew Romano
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Steven F Bolling
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
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9
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Taha A, Hjärpe A, Martinsson A, Nielsen SJ, Barbu M, Pivodic A, Lannemyr L, Bergfeldt L, Jeppsson A. Cardiopulmonary bypass management and risk of new-onset atrial fibrillation after cardiac surgery. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad153. [PMID: 37713475 PMCID: PMC10533753 DOI: 10.1093/icvts/ivad153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/10/2023] [Accepted: 09/13/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVES Cardiopulmonary bypass (CPB) management may potentially play a role in the development of new-onset atrial fibrillation (AF) after cardiac surgery. The aim of this study was to explore this potential association. METHODS Patients who underwent coronary artery bypass grafting and/or valvular surgery during 2016-2020 were included in an observational single-centre study. Data collected from the Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies registry and a local CPB database were merged. Associations between individual CPB variables (CPB and aortic clamp times, arterial and central venous pressure, mixed venous oxygen saturation, blood flow index, bladder temperature and haematocrit) and new-onset AF were analysed using multivariable logistic regression models adjusted for patient characteristics, comorbidities and surgical procedure. RESULTS Out of 1999 patients, 758 (37.9%) developed new-onset AF. Patients with new-onset postoperative AF were older, had a higher incidence of previous stroke, worse renal function and higher EuroSCORE II and CHA2DS2-VASc scores and more often underwent valve surgery. Longer CPB time [adjusted odds ratio 1.05 per 10 min (95% confidence interval 1.01-1.08); P = 0.008] and higher flow index [adjusted odds ratio 1.21 per 0.2 l/m2 (95% confidence interval 1.02-1.42); P = 0.026] were associated with an increased risk for new-onset AF, while the other variables were not. A sensitivity analysis only including patients with isolated coronary artery bypass grafting supported the primary analyses. CONCLUSIONS CPB management following current guideline recommendations appears to have minor or no influence on the risk of developing new-onset AF after cardiac surgery.
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Affiliation(s)
- Amar Taha
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Hjärpe
- Department of Anaesthesia and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Martinsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Susanne J Nielsen
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mikael Barbu
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Blekinge Hospital, Karlskrona, Sweden
| | - Aldina Pivodic
- APNC Sweden, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lukas Lannemyr
- Department of Anaesthesia and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Anaesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lennart Bergfeldt
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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10
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Dehmer GJ, Grines CL, Bakaeen FG, Beasley DL, Beckie TM, Boyd J, Cigarroa JE, Das SR, Diekemper RL, Frampton J, Hess CN, Ijioma N, Lawton JS, Shah B, Sutton NR. 2023 AHA/ACC Clinical Performance and Quality Measures for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Performance Measures. Circ Cardiovasc Qual Outcomes 2023; 16:e00121. [PMID: 37499042 DOI: 10.1161/hcq.0000000000000121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Affiliation(s)
| | | | | | | | | | | | | | - Sandeep R Das
- ACC/AHA Joint Committee on Performance Measures liaison
| | | | | | | | | | | | - Binita Shah
- Society for Cardiovascular Angiography and Interventions representative
| | - Nadia R Sutton
- AHA/ACC Joint Committee on Clinical Data Standards liaison
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11
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Liao X, Li S, Yan X, Lin X, Chen L, Lin Y. Association of preoperative CA-125 levels with early POAF after heart valve surgery: a single-center, retrospective study. BMC Surg 2023; 23:225. [PMID: 37559016 PMCID: PMC10413594 DOI: 10.1186/s12893-023-02099-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/06/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE Cancer antigen-125 (CA-125), a tumor marker, has received increasing attention in recent years for its role in the cardiovascular field. However, no study has reported the association of CA-125 with early postoperative atrial fibrillation (POAF) after heart valve surgery. Therefore, the aim of this study was to assess whether there is a correlation between CA-125 and early postoperative POAF after heart valve surgery. METHODS Patients who underwent valve surgery at Fujian Heart Medical Center from January 2020 to August 2022 were retrospectively analyzed and divided into postoperative atrial fibrillation group (POAF group) and postoperative non-atrial fibrillation group (NO-POAF), and the differences in clinical data between the two groups were compared, and the variables with statistical significance in the univariate analysis were included in the COX regression analysis, and finally the receivers' operating characteristics (ROC) curves were drawn. RESULTS From January 2020 to August 2022, a total of 1653 patients underwent valve surgery. A total of 344 patients were finally included, including 52 patients (15.1%) in the POAF group and 292 patients (84.9%) in the NO-POAF group. Univariate analysis showed higher CA-125 levels in patients in the POAF group than in those in the NO-POAF group [27.89 (13.64, 61.54), 14.48 (9.87, 24.08), P = 0.000]. Analysis of the incidence of POAF based on CA-125 quartiles showed an incidence of up to 29.2% in the highest quartile (> 27.88). Multivariate COX regression analysis showed that CA-125 [OR = 1.006, 95% CI (1.002, 1.010), P = 0.001] was an independent predictor of POAF. The final ROC curve plot showed that the area under the curve for CA-125 was 0.669, with an optimal cut-off value of 27.08 U/ml, and the difference in the area under the curve between the two groups was statistically significant (P = 0.000). CONCLUSION Elevated preoperative CA-125 levels can affect the incidence of POAF and have a predictive value for the occurrence of POAF in the early stage after valve surgery. However, due to the small sample size and single-center retrospective study, further validation of this result is needed.
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Affiliation(s)
- Xiaoqin Liao
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Sailan Li
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xin Yan
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xin Lin
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Liangwan Chen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yanjuan Lin
- Department of Nursing, Fujian Medical University Union Hospital, Fuzhou, China
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12
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Benson JM, Wang G, Hutt JA, Wu G, Kaminsky SM, Cram S, Barur R, Donahue JK. Preclinical safety and biodistribution assessment of Ad-KCNH2-G628S administered via atrial painting in New Zealand white rabbits. Basic Clin Pharmacol Toxicol 2023; 133:179-193. [PMID: 37177881 PMCID: PMC10935599 DOI: 10.1111/bcpt.13885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
Post-operative atrial fibrillation (POAF) is the most common complication after cardiac surgery. Despite implementation of several pharmacological strategies, incidence of POAF remains at approximately 30%. An adenovirus vector encoding KCNH2-G628S has proven efficacious in a porcine model of AF. In this preclinical study, 1.5 × 1010 or 1.5 × 1012 Ad-KCNH2-G628S vector particles (vp) were applied to the atrial epicardium or 1.5 × 1012 vp were applied to the whole epicardial surface of New Zealand White rabbits. Saline and vector vehicle served as procedure controls. Animals were followed for up to 42 days. Vector genomes persisted in the atria up to 42 days, with no distribution to extra-thoracic organs. There were no adverse effects attributable to test article on standard toxicological endpoints or on blood pressure, left atrial or ventricular ejection fractions, electrocardiographic parameters, or serum IL-6 or troponin concentrations. Mononuclear infiltration of the myocardium of the atrial free walls of low-dose, but not high-dose animals was observed at 7 and 21 days, but these changes did not persist or affect cardiac function. After scaling for heart size, results indicate the test article is safe at doses up to 25 times the maximum proposed for the human clinical trial.
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Affiliation(s)
- Janet M. Benson
- Applied Toxicology Program, Lovelace Biomedical Research Institute, Albuquerque, NM 87108, USA
| | - Gensheng Wang
- Applied Toxicology Program, Lovelace Biomedical Research Institute, Albuquerque, NM 87108, USA
- Baxter International, Inc. Deerfield, IL 60015, USA
| | - Julie A. Hutt
- Greenfield Pathology Services, Inc., Greenfield, IN 46140, USA
| | - Guodong Wu
- Applied Toxicology Program, Lovelace Biomedical Research Institute, Albuquerque, NM 87108, USA
| | - Stephen M. Kaminsky
- Weill Cornell Medicine, Belfer Gene Therapy Core Facility, New York, NY 10021, USA
| | - Sara Cram
- Weill Cornell Medicine, Belfer Gene Therapy Core Facility, New York, NY 10021, USA
| | - Rajeshkumar Barur
- Cardiovascular Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01605, USA
| | - J. Kevin Donahue
- Cardiovascular Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01605, USA
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13
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Parent S, Vaka R, Risha Y, Ngo C, Kanda P, Nattel S, Khan S, Courtman D, Stewart DJ, Davis DR. Prevention of atrial fibrillation after open-chest surgery with extracellular vesicle therapy. JCI Insight 2023; 8:e163297. [PMID: 37384420 PMCID: PMC10481795 DOI: 10.1172/jci.insight.163297] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 06/28/2023] [Indexed: 07/01/2023] Open
Abstract
Almost half of patients recovering from open-chest surgery experience atrial fibrillation (AF) that results principally from inflammation in the pericardial space surrounding the heart. Given that postoperative AF is associated with increased mortality, effective measures to prevent AF after open-chest surgery are highly desirable. In this study, we tested the concept that extracellular vesicles (EVs) isolated from human atrial explant-derived cells can prevent postoperative AF. Middle-aged female and male rats were randomized to undergo sham operation or induction of sterile pericarditis followed by trans-epicardial injection of human EVs or vehicle into the atrial tissue. Pericarditis increased the probability of inducing AF while EV treatment abrogated this effect in a sex-independent manner. EV treatment reduced infiltration of inflammatory cells and production of pro-inflammatory cytokines. Atrial fibrosis and hypertrophy seen after pericarditis were markedly attenuated by EV pretreatment, an effect attributable to suppression of fibroblast proliferation by EVs. Our study demonstrates that injection of EVs at the time of open-chest surgery shows prominent antiinflammatory effects and prevents AF due to sterile pericarditis. Translation of this finding to patients might provide an effective new strategy to prevent postoperative AF by reducing atrial inflammation and fibrosis.
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Affiliation(s)
- Sandrine Parent
- University of Ottawa Heart Institute, Division of Cardiology, Department of Medicine, and
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ramana Vaka
- University of Ottawa Heart Institute, Division of Cardiology, Department of Medicine, and
| | - Yousef Risha
- University of Ottawa Heart Institute, Division of Cardiology, Department of Medicine, and
| | - Clarissa Ngo
- University of Ottawa Heart Institute, Division of Cardiology, Department of Medicine, and
| | - Pushpinder Kanda
- University of Ottawa Heart Institute, Division of Cardiology, Department of Medicine, and
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Stanley Nattel
- Research Center and Department of Medicine, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
- Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Saad Khan
- Ottawa Hospital Research Institute, Division of Regenerative Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - David Courtman
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Division of Regenerative Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Duncan J. Stewart
- University of Ottawa Heart Institute, Division of Cardiology, Department of Medicine, and
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Division of Regenerative Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Darryl R. Davis
- University of Ottawa Heart Institute, Division of Cardiology, Department of Medicine, and
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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14
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Pujara AC, Koprivanac M, Stembal F, Lowry AM, Nowicki ER, Chung M, Wagoner DV, Blackstone EH, Roselli EE. Atrial Fibrillation after Descending Aorta Repair: Occurrence, Risk Factors, and Impact on Outcomes. AORTA (STAMFORD, CONN.) 2023; 11:116-124. [PMID: 37619569 PMCID: PMC10449568 DOI: 10.1055/s-0043-1770960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/26/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND As risks of repairing the descending thoracic and thoracoabdominal aorta diminish, common complications that may prolong hospital stay, or actually increase risk, require attention. One such complication is postoperative atrial fibrillation (AF). Therefore, we characterized prevalence of, risk factors for, and effects of postoperative atrial fibrillation (PoAF) after descending and thoracoabdominal aorta repair. METHODS From January 2000 to January 2011, 696 patients underwent open descending or thoracoabdominal aorta repair at Cleveland Clinic. Operations approached via median sternotomy (n = 178) and patients treated preoperatively for arrhythmias (32 amiodarone, 9 paced) or in AF on preoperative electrocardiogram (n = 14) were excluded, leaving 463. Logistic regression analysis identified risk factors for PoAF. Temporal relation of PoAF with postoperative morbidities was determined, and outcomes following PoAF were compared between propensity-matched pairs. RESULTS New-onset PoAF occurred in 101 patients (22%) at a median 68 hours of postincision. Risk factors included older age (p = 0.002) and history of remote AF (p = 0.0004) but not operative details, such as pericardiotomy for cardiac cannulation. Hypoperfusion and neurologic complications tended to precede PoAF, whereas sepsis, respiratory failure, and dialysis followed. Among 94 propensity-matched patient pairs, those developing PoAF were more likely to experience hypoperfusion (p = 0.006), respiratory failure (p = 0.009), dialysis (p = 0.04), paralysis (p < 0.0001), longer intensive care unit stay (median 7 vs. 5 d, p = 0.02), and longer postoperative hospital stay (median 15 vs. 13 d, p = 0.004). However, hospital death was similar (6/94 PoAF [6.4%] vs. 7/94 no PoAF [7.4%], p = 0.8). CONCLUSION PoAF after descending thoracic aorta surgery is relatively common and a part of a constellation of other serious complications prolonging postoperative recovery. While PoAF was associated with adverse events, it did not impact postoperative cost and mortality. Descending thoracic aorta surgery is by itself comorbid enough, which is likely why PoAF does not have a more significant effect on postoperative recovery and cost.
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Affiliation(s)
- Akshat C. Pujara
- Department of Thoracic and Cardiovascular Surgery, Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Marijan Koprivanac
- Department of Thoracic and Cardiovascular Surgery, Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Filip Stembal
- Department of Thoracic and Cardiovascular Surgery, Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ashley M. Lowry
- Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Edward R. Nowicki
- Department of Thoracic and Cardiovascular Surgery, Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mina Chung
- Department of Cardiovascular Medicine, Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - David V. Wagoner
- Department of Molecular Cardiology, Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H. Blackstone
- Department of Thoracic and Cardiovascular Surgery, Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eric E. Roselli
- Department of Thoracic and Cardiovascular Surgery, Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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15
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Rivas E, Shehata P, Bravo M, Almonacid-Cardenas F, Shah K, Kopac O, Ruetzler K, Troianos CA, Turan A. Association between obstructive sleep apnea and atrial fibrillation and delirium after cardiac surgery. Sub-analysis of DECADE trial. J Clin Anesth 2023; 87:111109. [PMID: 36958074 DOI: 10.1016/j.jclinane.2023.111109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Atrial fibrillation and delirium are common complications after cardiac surgery. Both are associated with increased Intensive Care Unit (ICU) and hospital length of stay, functional decline, 30-day mortality and increase in health care costs. Obstructive Sleep Apnea (OSA) induces deleterious effects in the cardiovascular and nervous systems. We hypothesized that adult patients with preoperative OSA have a higher incidence of postoperative atrial fibrillation and delirium than patients without OSA, after cardiac surgery. METHODS Sub-analysis of the DECADE trial at Cleveland Clinic hospitals. Our exposure was OSA, defined by STOP-BANG questionnaire score higher than 5 and/or a preoperative diagnosis of OSA. The primary outcome was atrial fibrillation, defined by clinician diagnosis or documented arrhythmia. The secondary outcome was delirium assessed twice during the initial five postoperative days using the Confusion Assessment Method for ICU. We assessed the association between OSA, and atrial fibrillation and delirium using a logistic regression model adjusted for confounders using inverse probability of treatment weighting. RESULTS 590 patients were included in the final analysis. 133 were diagnosed with OSA and 457 had no OSA. Satisfactory balance between groups for most confounders (absolute standardized difference < 0.10) was achieved after weighting. The atrial fibrillation incidence was 37% (n = 49) in the patients with OSA and 33% (n = 150) in the non-OSA patients. OSA was not associated with atrial fibrillation with an estimated odds ratio of 1.22 (95% CI: 0.75,1.99;p = 0.416). The delirium incidence was 17% (n = 22) in patients with OSA and 15% (n = 67) in the non-OSA patients. OSA was not associated with delirium with an estimated odds ratio of 0.93 (95% CI: 0.51,1.69;p = 0.800). CONCLUSION In adult patients having cardiac surgery, OSA is not associated with a higher incidence of postoperative atrial fibrillation and delirium. These results suggest different prominent factors rather than OSA affect the incidence of these postoperative outcomes.
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Affiliation(s)
- Eva Rivas
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States; Department of Anesthesia, Hospital Clinic of Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Peter Shehata
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Mauro Bravo
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States; Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States
| | | | - Karan Shah
- Department Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States
| | - Orkun Kopac
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Kurt Ruetzler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States; Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States
| | | | - Alparslan Turan
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States; Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States.
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16
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1250] [Impact Index Per Article: 1250.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Vorhofflimmern nach herzchirurgischen Eingriffen – Zusammenfassung der einer Metaanalyse. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2023. [DOI: 10.1007/s00398-023-00558-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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18
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Lee G, Tam DY, Fremes SE. Commentary: Until we take it seriously, the status quo of postoperative atrial fibrillation management will prevail. J Thorac Cardiovasc Surg 2023; 165:104-105. [PMID: 33985802 DOI: 10.1016/j.jtcvs.2021.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Grace Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Derrick Y Tam
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Stephen E Fremes
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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Atrial fibrillation after cardiac surgery: A systematic review and meta-analysis. J Thorac Cardiovasc Surg 2023; 165:94-103.e24. [PMID: 33952399 DOI: 10.1016/j.jtcvs.2021.03.077] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/05/2021] [Accepted: 03/12/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE New-onset postoperative atrial fibrillation (POAF) after cardiac surgery is common, with rates up to 60%. POAF has been associated with early and late stroke, but its association with other cardiovascular outcomes is less known. The objective was to perform a meta-analysis of the studies reporting the association of POAF with perioperative and long-term outcomes in patients with cardiac surgery. METHODS We performed a systematic review and a meta-analysis of studies that presented outcomes for cardiac surgery on the basis of the presence or absence of POAF. MEDLINE, EMBASE, and the Cochrane Library were assessed; 57 studies (246,340 patients) were selected. Perioperative mortality was the primary outcome. Inverse variance method and random model were performed. Leave-one-out analysis, subgroup analyses, and metaregression were conducted. RESULTS POAF was associated with perioperative mortality (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.58-2.33), perioperative stroke (OR, 2.17; 95% CI, 1.90-2.49), perioperative myocardial infarction (OR, 1.28; 95% CI, 1.06-1.54), perioperative acute renal failure (OR, 2.74; 95% CI, 2.42-3.11), hospital (standardized mean difference, 0.80; 95% CI, 0.53-1.07) and intensive care unit stay (standardized mean difference, 0.55; 95% CI, 0.24-0.86), long-term mortality (incidence rate ratio [IRR], 1.54; 95% CI, 1.40-1.69), long-term stroke (IRR, 1.33; 95% CI, 1.21-1.46), and longstanding persistent atrial fibrillation (IRR, 4.73; 95% CI, 3.36-6.66). CONCLUSIONS The results suggest that POAF after cardiac surgery is associated with an increased occurrence of most short- and long-term cardiovascular adverse events. However, the causality of this association remains to be established.
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Yavuz Ş, Özsin KK, Sanrı US, Toktaş F, Özsin M, Eriş C. Evaluation of the effect of preoperative HbA1c value on development of postoperative atrial fibrillation in diabetic patients with on-pump coronary artery bypass graft. J Card Surg 2022; 37:4371-4378. [PMID: 36229974 DOI: 10.1111/jocs.17028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 08/20/2022] [Accepted: 08/31/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND We aimed to determine the relationship between hemoglobin A1c (HbA1c) levels and the development of postoperative atrial fibrillation (PoAF). METHODS Two hundred and eighty-eight patients diagnosed with diabetes mellitus and undergoing on-pump coronary bypass were included in the study. Those with serum HbA1c levels between 5.5% and 7.0% were defined as Group 1, those with serum HbA1c levels between 7.1% and 8.9% were defined as Group 2, while those with serum HbA1c levels 9.0% and above formed Group 3. Data between groups were compared. The predictive values of the independent variables for the development of PoAF were measured. RESULTS We did not find a difference between groups in terms of development PoAF (p = .170). The presence of hypertension was determined as an independent predictor for the development of PoAF (p = .003), but not HbA1c levels (p = .134). There was 50.5% sensitivity and 61.1% specificity for HbA1c values of 9.06% and above to predict PoAF (area under curve: 0.571, p = .049). CONCLUSIONS HbA1c levels were not an independent predictor of PoAF development. However, we think that high HbA1c levels may be a risk factor for the development of PoAF.
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Affiliation(s)
- Şenol Yavuz
- Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
| | - Kadir Kaan Özsin
- Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
| | - Umut Serhat Sanrı
- Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
| | - Faruk Toktaş
- Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
| | - Meral Özsin
- Department of Medical Biochemistry, Faculty of Medicine, University of Kahramanmaraş Sütçü İmam, Kahramanmaraş, Turkey
| | - Cüneyt Eriş
- Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
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21
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Budak AB. Predictive power of elevated preoperative HbA1c levels for postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass surgery-Many questions to be asked and many answers to be given. J Card Surg 2022; 37:4379-4381. [PMID: 36229987 DOI: 10.1111/jocs.17026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 01/06/2023]
Abstract
The authors performed a detailed retrospective analysis of diabetic patients undergoing isolated coronary artery bypass graft surgery aiming to investigate the association of the preoperative glycosylated hemoglobin with occurrence of postoperative atrial fibrillation. Although statistical analysis showed a weak relationship between HbA1c values of 9.06% or above and postoperative atrial fibrillation (PoAF), they concluded that serum level of HbA1c could not be used as a predictor for the development of PoAF. But there are many questions to be asked and answers to be found.
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Affiliation(s)
- Ali Baran Budak
- Department of Cardiovascular Surgery, Ulus Liv Hospital, Istanbul, Turkey
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22
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Binder MS, Wu Y, Baker JW, Rowe JF, Wyatt DA, Choate C, Poelzing S, Joseph M. A retrospective comparison of albumin versus mannitol priming fluid with relation to postoperative atrial fibrillation. J Card Surg 2022; 37:3485-3491. [PMID: 36116062 PMCID: PMC9826347 DOI: 10.1111/jocs.16960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/10/2022] [Accepted: 08/27/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery which can result in increased mortality and increased healthcare costs. During Hurricane Maria (2017), a nationwide shortage of mannitol occurred, and our institution switched to the utilization of albumin as a priming fluid solution. We observed decreased rates of POAF during that time and began alternating albumin and mannitol priming fluid solutions. We hypothesized this observation may be from altered perinexal conduction from albumin utilization. METHODS A retrospective chart review of all patients from January 2020 through December 2020 who underwent cardiac surgery was performed, to determine if albumin was associated with reduced POAF rates. Two hundred and thirteen patients were identified and 4 were excluded. Two hundred and nine patients (110 albumin priming fluid and 99 mannitol priming fluid) were included in our final analysis. RESULTS Analysis was performed for all patients with POAF and in patients with new-onset AF (without a history of prior AF) after surgery. POAF rates showed no statistically significant difference between cohorts. For all patients, POAF occurred in 43% of the albumin subgroup and 47% of the mannitol subgroup (p = .53) and for patients with new-onset AF, POAF occurred in 35% of the albumin subgroup versus 42% of the mannitol subgroup (p = .36). Logistic regression revealed that age, ejection fraction and cardiopulmonary bypass time was associated with POAF, in our cohort. CONCLUSIONS The use of albumin compared to mannitol as priming fluid solutions was not associated with statistically significant reductions in POAF rate, in our population.
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Affiliation(s)
- M. Scott Binder
- Departments of Cardiology, Cardiothoracic SurgeryVirginia Tech CarilionRoanokeVirginiaUSA
| | - YingXing Wu
- Department of Health AnalyticsVirginia Tech CarilionRoanokeVirginiaUSA
| | - Joseph W. Baker
- Departments of Cardiology, Cardiothoracic SurgeryVirginia Tech CarilionRoanokeVirginiaUSA
| | - Joseph F. Rowe
- Departments of Cardiology, Cardiothoracic SurgeryVirginia Tech CarilionRoanokeVirginiaUSA
| | - David A. Wyatt
- Departments of Cardiology, Cardiothoracic SurgeryVirginia Tech CarilionRoanokeVirginiaUSA
| | - Cynthia Choate
- Departments of Cardiology, Cardiothoracic SurgeryVirginia Tech CarilionRoanokeVirginiaUSA
| | - Steven Poelzing
- Department of Biomedical Engineering and MechanicsVirginia Tech Fralin Biomedical Research InstituteRoanokeVirginiaUSA
| | - Mark Joseph
- Departments of Cardiology, Cardiothoracic SurgeryVirginia Tech CarilionRoanokeVirginiaUSA
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Stone KH, Reynolds K, Davis S, Van Tassell BW, Gibson CM. Comparison of new-onset post-operative atrial fibrillation between patients receiving carvedilol and metoprolol after off-pump coronary artery bypass graft surgery. Gen Thorac Cardiovasc Surg 2022; 71:299-305. [PMID: 36180608 DOI: 10.1007/s11748-022-01877-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/23/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Post-operative atrial fibrillation (POAF) is a common complication of coronary artery bypass graft (CABG) surgery. Previous studies suggest carvedilol is more effective than metoprolol in preventing POAF in on-pump CABG. This study investigated if the same benefit would be seen in off-pump CABG. METHODS This single-center, retrospective review compared rates of new-onset POAF between adult patients who received carvedilol and metoprolol after off-pump CABG surgery. Safety endpoints included hypotension, bradycardia, dyspnea, and the composite. Multivariate logistic regression was conducted to identify associations between demographics, potential confounders, and beta-blocker dose and POAF. Kaplan-Meier plots and Cox proportional-hazards models examined differences in time-to-event for POAF. RESULTS 134 patients were included (34 carvedilol and 100 metoprolol). The mean age was 63 years, 70.9% were male, 85% had history of hypertension, 3.7% had history of heart failure with reduced ejection fraction, and 38.8% were taking beta blockers prior to admission. POAF developed in 2 patients (5.8%) in the carvedilol group and 24 patients (24.0%) in the metoprolol group (odds ratio 0.17 [95% CI 0.03-0.83], p = 0.023). Safety endpoints occurred in 10 carvedilol (29.4%) and 44 metoprolol (44.0%) patients (p = 0.134). Hypotension and dyspnea rates were similar between groups; bradycardia occurred more commonly among metoprolol-treated patients (p = 0.040). Time-to-event analyses revealed a hazard ratio = 0.22 (95% CI 0.05-0.93, p = 0.040) for carvedilol use. CONCLUSIONS In this single-center, retrospective study of off-pump CABG patients, carvedilol was associated with reduced POAF risk and enhanced safety compared to metoprolol.
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Affiliation(s)
- Keeley H Stone
- Medical City Arlington, 3301 Matlock Road, Arlington, TX, 76015, USA
- Texas Health Harris Methodist Hospital, 1301 Pennsylvania Ave, Fort Worth, TX, 76104, USA
| | - Katie Reynolds
- Medical City Arlington, 3301 Matlock Road, Arlington, TX, 76015, USA
| | - Sondra Davis
- Medical City Arlington, 3301 Matlock Road, Arlington, TX, 76015, USA
| | - Benjamin W Van Tassell
- Virginia Commonwealth University School of Pharmacy, 410 N. 12th Street, Richmond, VA, 23298, USA
| | - Caitlin M Gibson
- Medical City Arlington, 3301 Matlock Road, Arlington, TX, 76015, USA.
- Virginia Commonwealth University School of Pharmacy, 410 N. 12th Street, Richmond, VA, 23298, USA.
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Gong J, Wei Y, Zhang Q, Tang J, Chang Q. Nomogram predicts atrial fibrillation after coronary artery bypass grafting. BMC Cardiovasc Disord 2022; 22:388. [PMID: 36042409 PMCID: PMC9429785 DOI: 10.1186/s12872-022-02824-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/16/2022] [Indexed: 11/12/2022] Open
Abstract
Objective Using the nomogram to intuitively predict atrial fibrillation after coronary artery bypass grafting. Identify high-risk patients with atrial fibrillation and provide preoperative protective therapy. Methods A total of 397 patients that underwent coronary artery bypass grafting were consecutively enrolled. Independent predictors of patients were analyzed by multivariate logistic regression. Two nomograms were constructed to predict postoperative atrial fibrillation. Results The incidence of postoperative atrial fibrillation in this study was 29% (115/397). Multivariate Logistic showed that Age, Operative Time > 4 h, Left Atrial Diameter > 40 mm, Mean Arterial Pressure, Body Mass Index > 23 kg/m2, Insulins, and Statins were independently associated with atrial fibrillation after isolated coronary artery bypass grafting. The nomogram of postoperative atrial fibrillation in patients was constructed using total predictor variables (AUC = 0.727, 95% CI 0.673–0.781). The model was internally validated (AUC = 0.701) by K-fold Cross-validation resampling (K = 5, Times = 400). To make an early intervention, the intraoperative information of the patients was excluded. Only 6 variables before surgery were used to establish the brief nomogram to predict postoperative atrial fibrillation (AUC = 0.707, 95% CI 0.651–0.764). The brief model was internally validated (AUC = 0.683) by resampling with K-fold Cross-validation resampling. Conclusions These two nomograms could be used to predict patients at high risk for atrial fibrillation after isolated coronary artery bypass grafting.
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Affiliation(s)
- Jingshuai Gong
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Yangyan Wei
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Qian Zhang
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Jiwen Tang
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Qing Chang
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China.
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Magoon R, Jose J. Evaluating biomarkers of post-cardiac surgery vasodilatory shock: Research caveats be concurrently marked. J Crit Care 2022; 70:154027. [DOI: 10.1016/j.jcrc.2022.154027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
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Madsen CV, Park-Hansen J, Holme SJV, Irmukhamedov A, Carranza CL, Greve AM, Al-Farra G, Riis RGC, Nilsson B, Clausen JSR, Nørskov AS, Kruuse C, Truelsen TC, Dominguez H. Randomized Trial of Surgical Left Atrial Appendage Closure: Protection Against Cerebrovascular Events. Semin Thorac Cardiovasc Surg 2022; 35:664-672. [PMID: 35777693 DOI: 10.1053/j.semtcvs.2022.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 01/31/2023]
Abstract
Following open-heart surgery, atrial fibrillation and stroke occur frequently. Left atrial appendage closure added to elective open-heart surgery could reduce the risk of ischemic stroke. We aim to examine if routine closure of the left atrial appendage in patients undergoing open-heart surgery provides long-term protection against cerebrovascular events independently of atrial fibrillation history, stroke risk, and oral anticoagulation use. Long-term follow-up of patients enrolled in the prospective, randomized, open-label, blinded evaluation trial entitled left atrial appendage closure by surgery (NCT02378116). Patients were stratified by oral anticoagulation status and randomized (1:1) to left atrial appendage closure in addition to elective open-heart surgery vs standard care. The primary composite endpoint was ischemic stroke events, transient ischemic attacks, and imaging findings of silent cerebral ischemic lesions. Two neurologists blinded for treatment assignment adjudicated cerebrovascular events. In total, 186 patients (82% males) were reviewed. At baseline, mean (standard deviation (SD)) age was68 (9) years and 13.4% (n = 25/186) had been diagnosed with atrial fibrillation. Median [interquartile range (IQR)] CHA2DS2-VASc was 3 [2,4] and 25.9% (n = 48/186) were receiving oral anticoagulants. Mean follow-up was 6.2 (2.5) years. The left atrial appendage closure group experienced fewer cerebrovascular events; intention-to-treat 11 vs 19 (P = 0.033, n = 186) and per-protocol 9 vs 17 (P = 0.186, n = 141). Left atrial appendage closure as an add-on open-heart surgery, regardless of pre-surgery atrial fibrillation and oral anticoagulation status, seems safe and may reduce cerebrovascular events in long-term follow-up. More extensive randomized clinical trials investigating left atrial appendage closure in patients without atrial fibrillation and high stroke risk are warranted.
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Affiliation(s)
- Christoffer V Madsen
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Biomedical Science, University of Copenhagen, Copenhagen, Denmark.
| | - Jesper Park-Hansen
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Susanne J V Holme
- Department of Cardio-Thoracic Surgery, Copenhagen University Hospital - Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - Akhmadjon Irmukhamedov
- Department of Heart, Lung, and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Christian L Carranza
- Department of Cardio-Thoracic Surgery, Copenhagen University Hospital - Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - Anders M Greve
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Gina Al-Farra
- Department of Radiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Robert G C Riis
- Department of Radiology, Copenhagen University Hospital - Rigshospitalet-Glostrup Hospital, Copenhagen, Denmark
| | - Brian Nilsson
- Department of Cardiology, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Johan S R Clausen
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Biomedical Science, University of Copenhagen, Copenhagen, Denmark
| | - Anne S Nørskov
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Biomedical Science, University of Copenhagen, Copenhagen, Denmark
| | - Christina Kruuse
- Department of Neurology, Neurovascular Research Unit, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Thomas C Truelsen
- Department of Neurology, Copenhagen University Hospital - Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - Helena Dominguez
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Biomedical Science, University of Copenhagen, Copenhagen, Denmark
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2460] [Impact Index Per Article: 1230.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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A novel electrocardiographic parameter for the prediction of atrial fibrillation after coronary artery bypass graft surgery "P wave peak time". Ir J Med Sci 2022; 191:2579-2585. [PMID: 35034275 DOI: 10.1007/s11845-021-02894-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/07/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Patients with postoperative atrial fibrillation (POAF) have increased risk of both short- and long-term mortality and morbidity; therefore, prediction of POAF is crucial in the preoperative period of the patients undergoing coronary artery bypass graft surgery. Electrocardiography (ECG) is the simplest and cost-effective tool in the preoperative workup of the patients for the prediction of POAF. A newly defined ECG parameter P wave peak time (PWPT) has been shown as a marker of atrial fibrillation development in non-surgical patients and we investigated its role in patients undergoing cardiac surgery. METHOD A total of 327 patients undergoing isolated or combined cardiac surgery were involved and the primary endpoint was defined as the development of POAF. The study population was divided into two groups based on the presence or absence of POAF. Groups were compared for both standard P wave parameters and for PWPT on surface ECG. The predictors of POAF were assessed by multivariate regression analysis. RESULTS The frequency of POAF was 20.4% (n = 67). P wave peak time in leads D2 (65.1 ± 11.8 vs 57.2 ± 10, p < 0.01) and V1 (57.8 ± 18 vs 44.8 ± 12.3, p < 0.01) were longer in patients with POAF. In multivariate regression analysis, PWPT in leads DII and V1 were independent predictors of POAF (OR: 1.11, 95%CI: 1.02-1.21, p = 0.01, OR: 1.06, 95%CI: 1.00-1.13, p = 0.03 respectively). CONCLUSION PWPT in leads DII and V1 can predict the development of POAF in patients undergoing cardiac surgery.
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6571148. [DOI: 10.1093/ejcts/ezac264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/31/2022] [Accepted: 04/15/2022] [Indexed: 11/14/2022] Open
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Riad FS, German K, Deitz S, Sahadevan J, Sundaram V, Waldo AL. Contemporary Anticoagulation Practices for Postoperative Atrial Fibrillation: A Single Center Experience. J Atr Fibrillation 2021; 13:2443. [PMID: 34950327 DOI: 10.4022/jafib.2443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/11/2020] [Accepted: 10/12/2020] [Indexed: 11/10/2022]
Abstract
Aims Postoperative atrial fibrillation (POAF) is a frequent in-hospital complication after cardiac surgery. Surprisingly, despite its prevalence, management of this condition has not been well studied. One promising approach that has been evaluated in a limited number of studies is use of anticoagulation. However, the trends and patterns of real-world use of anticoagulation in POAF patients has not been systemically investigated. In this study, we aimed to determine real-world patterns of anticoagulation use for patients with POAF. Methods We identified 200 patients undergoing coronary artery bypass (CABG) or cardiac valve surgery at University Hospitals Cleveland Medical Center over a 2 year period beginning January 2016 with new onset POAF. We reviewed charts to verify candidacy for inclusion in the study and to extract data on anticoagulation use, adverse outcomes, and CHA2DS2-VASc scores. Results Anticoagulation use was low after CABG, but high after bioprosthetic valve surgery. The most common anticoagulant used was warfarin. Anticoagulation use was not correlated with CHA2DS2-VASc score or cardioversion. Stroke and mortality were higher among patients not receiving anticoagulation, however, confirmation of this finding in larger randomized studies is warranted. Conclusions Anticoagulation use is low after CABG and this practice does not appear to be affected by CHA2DS2VASc score or cardioversion. This differs with previously reported provider attitudes towards management of this condition. Stroke and mortality appear to be elevated for patients not receiving anticoagulation but further investigation is required to confirm this observation.
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Affiliation(s)
- Fady S Riad
- aHarrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University, Cleveland, OH
| | - Konstantin German
- aHarrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University, Cleveland, OH
| | - Sarah Deitz
- aHarrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University, Cleveland, OH
| | - Jayakumar Sahadevan
- aHarrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University, Cleveland, OH.,Department of Medicine, Louis Stokes Veteran Affairs Medical Center, Cleveland, Ohio
| | - Varun Sundaram
- aHarrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University, Cleveland, OH
| | - Albert L Waldo
- aHarrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University, Cleveland, OH
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 145:e18-e114. [PMID: 34882435 DOI: 10.1161/cir.0000000000001038] [Citation(s) in RCA: 139] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. Structure: Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 79:e21-e129. [PMID: 34895950 DOI: 10.1016/j.jacc.2021.09.006] [Citation(s) in RCA: 535] [Impact Index Per Article: 178.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. STRUCTURE Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.
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Association between perioperative hypotension and postoperative delirium and atrial fibrillation after cardiac surgery: A post-hoc analysis of the DECADE trial. J Clin Anesth 2021; 76:110584. [PMID: 34784557 DOI: 10.1016/j.jclinane.2021.110584] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE To test the hypotheses that in adults having cardiac surgery with cardio-pulmonary bypass, perioperative hypotension increases the risk of delirium and atrial fibrillation during the initial five postoperative days. DESIGN Sub-analysis of the DECADE multi-center randomized trial. SETTING Patients who had cardiac surgery with cardiopulmonary bypass at the Cleveland Clinic. INTERVENTIONS In the underlying trial, patients were randomly assigned 1:1 to dexmedetomidine or normal saline placebo. MEASUREMENTS Intraoperative mean arterial pressures were recorded at 1-min intervals from arterial catheters or at 1-5-min intervals oscillometrically. Postoperative blood pressures were recorded every half-hour or more often. The co-primary outcomes were atrial fibrillation and delirium occurring between intensive care unit admission and the earlier of postoperative day 5 or hospital discharge. Delirium was assessed twice daily during the initial 5 postoperative days while patients remained hospitalized with the Confusion Assessment Method for the intensive care unit. Assessments were made by trained research fellows who were blinded to the dexmedetomidine administration. MAIN RESULTS There was no significant association between intraoperative hypotension and delirium, with an adjusted odds ratio of 0.94 (95% CI: 0.81, 1.09; P = 0.419) for a doubling in AUC of mean arterial pressure (MAP) <60 mmHg. An increase in intraoperative AUC of MAP <60 mmHg was not significantly associated with the odds of atrial fibrillation (adjusted odds ratio = 0.99; 95% CI: 0.87, 1.11; P = 0.819). Postoperative MAP <70 mmHg per hour 1.14 (97.5% CI: 1.04,1.26; P = 0.002) and MAP <80 mmHg per hour 1.05 (97.5%: 1.01, 1.10; P = 0.010) were significantly associated with atrial fibrillation. CONCLUSIONS In patients having cardiac surgery with cardio-pulmonary bypass, neither intraoperative nor postoperative hypotension were associated with delirium. Postoperative hypotension was associated with atrial fibrillation, although intraoperative hypotension was not.
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Neves IA, Magalhães A, Lima da Silva G, Almeida AG, Borges M, Costa J, Ferreira JJ, Pinto FJ, Caldeira D. Anticoagulation therapy in patients with post-operative atrial fibrillation: Systematic review with meta-analysis. Vascul Pharmacol 2021; 142:106929. [PMID: 34757209 DOI: 10.1016/j.vph.2021.106929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/10/2021] [Accepted: 10/19/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Post-operative atrial fibrillation (POAF) is a relevant complication after surgery. Several studies have shown that POAF has important consequences for long-term morbidity and mortality, by increasing the risk of thromboembolic events. However, the use of oral anticoagulation (OAC) is not well established in this context. METHODS We searched MEDLINE, CENTRAL, PsycInfo and Web of Science for clinical trials and observational studies evaluating anticoagulation vs. no anticoagulation in patients with POAF (after cardiac or non-cardiac surgery). Data were screened and extracted by two independent reviewers. We performed a random- effects model to estimate the pooled odds ratio (OR) with 95% Confidence Intervals (CI), and heterogeneity was evaluated by I2 statistics. The outcomes of interest were all-cause mortality, thromboembolic events, and bleeding events. RESULTS Overall, 10 observational retrospective studies were included: 5 studies with 203,946 cardiac surgery POAF patients, and 5 studies with 29,566 patients with POAF after non-cardiac surgery. In cardiac surgery POAF, the OAC use was associated with lower risk of thromboembolic events (OR 0.68; 95%CI 0.47-0.96, I2 = 31%; 4 studies) and the bleeding risk was significantly increased (OR 4.30; 95%CI 3.69 to 5.02, 1 study). In non-cardiac surgery POAF, OAC did not significantly reduce the risk of thromboembolic events (OR 0.71, 95%CI 0.33-1.15; I2 = 79%; 5 studies) but was associated with increased risk of bleeding (OR 1.20, 95%CI 1.10-1.32, I2 = 0%; 3 studies). Mortality was not significantly reduced in both cardiac and non-cardiac surgery POAF. CONCLUSION Oral anticoagulation was associated with a lower risk of thromboembolic events in patients with POAF following cardiac surgery but not in non-cardiac surgery. Bleeding risk was increased in both settings. The confidence on pooled results is at most low, and further data, namely randomized controlled trials are necessary to derive robust conclusions.
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Affiliation(s)
| | - Andreia Magalhães
- Centro Cardiovascular da Universidade de Lisboa, CAML, Faculdade de Medicina da Universidade de Lisboa, Portugal; Cardiology Department, Hospital Santa Maria - Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon, Portugal
| | - Gustavo Lima da Silva
- Centro Cardiovascular da Universidade de Lisboa, CAML, Faculdade de Medicina da Universidade de Lisboa, Portugal; Cardiology Department, Hospital Santa Maria - Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon, Portugal
| | - Ana G Almeida
- Centro Cardiovascular da Universidade de Lisboa, CAML, Faculdade de Medicina da Universidade de Lisboa, Portugal; Cardiology Department, Hospital Santa Maria - Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon, Portugal
| | - Margarida Borges
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal; Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - João Costa
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal; Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal; Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Portugal; CNS - Neurological Senior Campus, Torres Vedras, Portugal
| | - Fausto J Pinto
- Centro Cardiovascular da Universidade de Lisboa, CAML, Faculdade de Medicina da Universidade de Lisboa, Portugal; Cardiology Department, Hospital Santa Maria - Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon, Portugal
| | - Daniel Caldeira
- Centro Cardiovascular da Universidade de Lisboa, CAML, Faculdade de Medicina da Universidade de Lisboa, Portugal; Cardiology Department, Hospital Santa Maria - Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon, Portugal; Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal.
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Seo EJ, Hong J, Lee HJ, Son YJ. Perioperative risk factors for new-onset postoperative atrial fibrillation after coronary artery bypass grafting: a systematic review. BMC Cardiovasc Disord 2021; 21:418. [PMID: 34479482 PMCID: PMC8414730 DOI: 10.1186/s12872-021-02224-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 08/24/2021] [Indexed: 12/20/2022] Open
Abstract
Background Postoperative atrial fibrillation (POAF) is the most common cardiac dysrhythmia to occur after coronary artery bypass grafting (CABG). However, the risk factors for new-onset POAF after CABG during the perioperative period have yet to be clearly defined. Accordingly, the aim of our systematic review was to evaluate the perioperative predictors of new-onset POAF after isolated CABG. Method Our review methods adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. We searched seven electronic databases (PubMed, Embase, CINAHL, PsycArticles, Cochrane, Web of Science, and SCOPUS) to identify all relevant English articles published up to January 2020. Identified studies were screened independently by two researchers for selection, according to predefined criteria. The Newcastle–Ottawa Scale was used to evaluate the quality of studies retained. Results After screening, nine studies were retained for analysis, including 4798 patients, of whom 1555 (32.4%) experienced new-onset POAF after CABG. The incidence rate of new-onset POAF ranged between 17.3% and 47.4%. The following risk factors were identified: old age (p < 0.001), a high preoperative serum creatinine level (p = 0.001), a low preoperative hemoglobin level (p = 0.007), a low left ventricle ejection fraction in Asian patients (p = 0.001), essential hypertension (p < 0.001), chronic obstructive pulmonary disease (p = 0.010), renal failure (p = 0.009), cardiopulmonary bypass use (p = 0.002), perfusion time (p = 0.017), postoperative use of inotropes (p < 0.001), postoperative renal failure (p = 0.001), and re-operation (p = 0.005). All studies included in the analysis were of good quality. Conclusions The risk factors identified in our review could be used to improve monitoring of at-risk patients for early detection and treatment of new-onset POAF after CABG, reducing the risk of other complications and negative clinical outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02224-x.
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Affiliation(s)
- Eun Ji Seo
- Ajou University College of Nursing and Research Institute of Nursing Science, Suwon, 16499, Republic of Korea
| | - Joonhwa Hong
- Department of Thoracic and Cardiovascular Surgery, Chung-Ang University, Seoul, 06974, Republic of Korea
| | - Hyeon-Ju Lee
- Department of Nursing, Tongmyoung University, Busan, 48520, Republic of Korea
| | - Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro Dongjak-Gu, Seoul, 06974, Republic of Korea.
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Miura S, Imahori T, Sugihara M, Mizobe T, Aihara H, Fukase K, Matsumori M, Murakami H, Hosoda K, Sasayama T, Kohmura E. Subarachnoid hemorrhage associated with cerebral hyperperfusion syndrome after simultaneous carotid endarterectomy and coronary artery bypass grafting procedures: A case report and review of the literature. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ha ACT, Verma S, Mazer CD, Quan A, Yanagawa B, Latter DA, Yau TM, Jacques F, Brown CD, Singal RK, Yamashita MH, Saha T, Teoh KH, Lam BK, Deyell MW, Wilson M, Hibino M, Cheung CC, Kosmopoulos A, Garg V, Brodutch S, Teoh H, Zuo F, Thorpe KE, Jüni P, Bhatt DL, Verma A. Effect of Continuous Electrocardiogram Monitoring on Detection of Undiagnosed Atrial Fibrillation After Hospitalization for Cardiac Surgery: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2121867. [PMID: 34448866 PMCID: PMC8397929 DOI: 10.1001/jamanetworkopen.2021.21867] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IMPORTANCE Postoperative atrial fibrillation (POAF) occurring after cardiac surgery is associated with adverse outcomes. Whether POAF persists beyond discharge is not well defined. OBJECTIVE To determine whether continuous cardiac rhythm monitoring enhances detection of POAF among cardiac surgical patients during the first 30 days after hospital discharge compared with usual care. DESIGN, SETTING, AND PARTICIPANTS This study is an investigator-initiated, open-label, multicenter, randomized clinical trial conducted at 10 Canadian centers. Enrollment spanned from March 2017 to March 2020, with follow-up through September 11, 2020. As a result of the COVID-19 pandemic, enrollment stopped on July 17, 2020, at which point 85% of the proposed sample size was enrolled. Cardiac surgical patients with CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, prior stroke or transient ischemic attack, vascular disease, age 65-74 years, female sex) score greater than or equal to 4 or greater than or equal to 2 with risk factors for POAF, no history of preoperative AF, and POAF lasting less than 24 hours during hospitalization were enrolled. INTERVENTIONS The intervention group underwent continuous cardiac rhythm monitoring with wearable, patch-based monitors for 30 days after randomization. Monitoring was not mandated in the usual care group within 30 days after randomization. MAIN OUTCOMES AND MEASURES The primary outcome was cumulative AF and/or atrial flutter lasting 6 minutes or longer detected by continuous cardiac rhythm monitoring or by a 12-lead electrocardiogram within 30 days of randomization. Prespecified secondary outcomes included cumulative AF lasting 6 hours or longer and 24 hours or longer within 30 days of randomization, death, myocardial infarction, ischemic stroke, non-central nervous system thromboembolism, major bleeding, and oral anticoagulation prescription. RESULTS Of the 336 patients randomized (163 patients in the intervention group and 173 patients in the usual care group; mean [SD] age, 67.4 [8.1] years; 73 women [21.7%]; median [interquartile range] CHA2DS2-VASc score, 4.0 [3.0-4.0] points), 307 (91.4%) completed the trial. In the intent-to-treat analysis, the primary end point occurred in 32 patients (19.6%) in the intervention group vs 3 patients (1.7%) in the usual care group (absolute difference, 17.9%; 95% CI, 11.5%-24.3%; P < .001). AF lasting 6 hours or longer was detected in 14 patients (8.6%) in the intervention group vs 0 patients in the usual care group (absolute difference, 8.6%; 95% CI, 4.3%-12.9%; P < .001). CONCLUSIONS AND RELEVANCE In post-cardiac surgical patients at high risk of stroke, no preoperative AF history, and AF lasting less than 24 hours during hospitalization, continuous monitoring revealed a significant increase in the rate of POAF after discharge that would otherwise not be detected by usual care. Studies are needed to examine whether these patients will benefit from oral anticoagulation therapy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02793895.
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Affiliation(s)
- Andrew C. T. Ha
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Subodh Verma
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - C. David Mazer
- Department of Anesthesiology, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Adrian Quan
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Bobby Yanagawa
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - David A. Latter
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Terrence M. Yau
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Frédéric Jacques
- University Institute of Cardiology and Respirology of Québec, Quebec City, Quebec, Canada
| | - Craig D. Brown
- Division of Cardiac Surgery, New Brunswick, Saint John, New Brunswick, Canada
| | - Rohit K. Singal
- Division of Surgery, Cardiac Science Program, St Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Michael H. Yamashita
- Division of Surgery, Cardiac Science Program, St Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Tarit Saha
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Kingston, Ontario, Canada
| | - Kevin H. Teoh
- Southlake Regional Health Center, University of Toronto, Newmarket, Ontario, Canada
| | - Buu-Khanh Lam
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marc W. Deyell
- Division of Cardiology, St Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Marnee Wilson
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Makoto Hibino
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Andrew Kosmopoulos
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Vinay Garg
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Shira Brodutch
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Hwee Teoh
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Fei Zuo
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
| | - Kevin E. Thorpe
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
| | - Deepak L. Bhatt
- Heart and Vascular Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Atul Verma
- Southlake Regional Health Center, University of Toronto, Newmarket, Ontario, Canada
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Ince I, Chiu A, Sagir A, Chahar P, Lin J, Douglas A, Adi A, Fang J, Mao G, Turan A. Association of Pain With Atrial Fibrillation and Delirium After Cardiac Surgery: A DECADE Sub-Study. J Cardiothorac Vasc Anesth 2021; 35:3021-3026. [PMID: 34148803 DOI: 10.1053/j.jvca.2021.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The authors aimed to evaluate the effects of postoperative pain on the incidence of atrial fibrillation and delirium in patients having surgery with cardiopulmonary bypass (CPB). DESIGN Post hoc analysis of the (An investigator-initiated, multicentre, double-blind trial (ClinicalTrials NCT02004613) (DECADE)), a randomized, placebo-controlled trial. SETTING Tertiary, academic hospital. PARTICIPANTS Six hundred five adults from the DECADE enrolled at Cleveland Clinic Main Campus, who had had surgery with CPB. INTERVENTIONS Dexmedetomidine versus placebo started before surgical incision and postoperatively was maintained until 24 hours. MEASUREMENTS Primary outcomes were atrial fibrillation, diagnosed by clinicians in the intensive care unit (ICU), presence of delirium assessed with the Confusion Assessment Method for the ICU, data on pain scores, and opioid consumption, occurring between ICU admission and the earlier of postoperative day five or hospital discharge. RESULTS Postoperative pain levels were similar among patients with or without atrial fibrillation. Two hundred six (34%) patients had atrial fibrillation and ninety-two (15%) had delirium before hospital discharge within the first five postoperative days. The risk of atrial fibrillation was not significantly different between groups (hazard ratio: 1.09; 97.5% confidence interval [CI]: 0.99, 1.20, p = 0.039); there were no associations between postoperative pain and the risk of postoperative delirium (hazard ratio: 0.96; 97.5% CI: 0.84-1.11; p = 0.57). Postoperative opioid consumption was neither significantly associated with postoperative atrial fibrillation nor delirium. CONCLUSIONS Atrial fibrillation and delirium was not associated with pain after cardiac surgery. Opioid use was not associated with atrial fibrillation and delirium. Because both atrial fibrillation and delirium have a multifactorial nature, further studies should be focused on other plausible mechanisms.
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Affiliation(s)
- Ilker Ince
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH; Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - Andrew Chiu
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH
| | - Afrin Sagir
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Praveen Chahar
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH; Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Jia Lin
- Department of Cardiovascular Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Aaron Douglas
- Department of Cardiovascular Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Ahmad Adi
- Department of Cardiovascular Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Jonathan Fang
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH
| | - Guangmei Mao
- Department Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Alparslan Turan
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH; Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH.
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Abdelmoneim SS, Rosenberg E, Meykler M, Patel B, Reddy B, Ho J, Klem I, Singh J, Worku B, Tranbaugh RF, Sacchi TJ, Heitner JF. The Incidence and Natural Progression of New-Onset Postoperative Atrial Fibrillation. JACC Clin Electrophysiol 2021; 7:1134-1144. [PMID: 33933413 DOI: 10.1016/j.jacep.2021.02.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to characterize the natural progression and recurrence of new-onset postoperative atrial fibrillation (POAF) during an intermediate-term follow-up post cardiac surgery by using continuous event monitoring. BACKGROUND New-onset POAF is a common complication after cardiac surgery and is associated with an increased risk for stroke and all-cause mortality. Long-term data on new POAF recurrence and anticoagulation remain sparse. METHODS This is a single-center, prospective observational study evaluating 42 patients undergoing cardiac surgery and diagnosed during indexed admission with new-onset, transient, POAF between May 2015 and December 2019. Before discharge, all patients received implantable loop recorders for continuous monitoring. Study outcomes were the presence and timing of atrial fibrillation (AF) recurrence (first, second, and more than 2 AF recurrences), all-cause mortality, and cerebrovascular accidents. A "per-month interval" analysis of proportion of patients with any AF recurrence was assessed and reported per period of follow-up time. Kaplan-Meier analysis was used to calculate the time to first AF recurrence and report the first AF recurrence rates. RESULTS Forty-two patients (mean age 67.6 ± 9.6 years, 74% male, mean CHADS2-VASc 3.5 ± 1.5) were evaluated during a mean follow-up of 1.7 ± 1.2 years. AF recurrence after discharge occurred in 30 patients (71%) and of those, 59% had AF episodes equal to or longer than 5 minutes (median AF duration at 1 month was 32 minutes [interquartile range 5.5-106], whereas median AF duration beyond 1 month was 15 minutes [interquartile range 6.3-49]). Twenty-four (80%) of the 30 patients had their first AF recurrence within the first month. During months 1 to 12 follow-up, 76% of patients had any AF recurrences (10% had their first AF recurrence, 43% had their second AF recurrence, and 23% had more than 2 AF recurrences). Beyond 1 year of follow-up, 30% of patients had any AF recurrences (10% had their first AF recurrence, 7% had their second AF recurrence, and 13% had more than 2 AF recurrences). Using Kaplan-Meier analysis, the median time to first AF recurrence was 0.83 months (95% confidence interval: 0.37 to 6) and the detection of first AF recurrence rate at 1, 3, 6, 12, 18, and 24 months was 57.1%, 59.5%, 64.3%, 64.3%, 67.3%, and 73.2%, respectively. During follow-up, there was 1 death ([-] AF recurrence) and 2 cerebrovascular accidents ([+] AF recurrence). CONCLUSIONS In this study of continuous monitoring with implantable loop recorders, the recurrence of AF in patients who develop transient POAF is common in the first month postoperatively. Of the patients who developed postoperative AF, 76% had any recurrence in months 1 to 12, and 30% had any recurrence beyond 1-year follow-up. Current guidelines recommend anticoagulation for POAF for 30 days. The results of this study warrant further investigation into continued monitoring and longer-term anticoagulation in this population within the context of our findings that AF duration was less than 30 minutes beyond 1 month.
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Affiliation(s)
- Sahar S Abdelmoneim
- Division of Cardiology, Weill Cornell Medicine, New York-Presbyterian Brooklyn Hospital, Brooklyn, New York, USA
| | - Emelie Rosenberg
- Division of Cardiology, Weill Cornell Medicine, New York-Presbyterian Brooklyn Hospital, Brooklyn, New York, USA
| | - Marcella Meykler
- Division of Cardiology, Weill Cornell Medicine, New York-Presbyterian Brooklyn Hospital, Brooklyn, New York, USA
| | - Bimal Patel
- Division of Cardiology, Weill Cornell Medicine, New York-Presbyterian Brooklyn Hospital, Brooklyn, New York, USA
| | - Bharath Reddy
- Division of Cardiology, Weill Cornell Medicine, New York-Presbyterian Brooklyn Hospital, Brooklyn, New York, USA
| | - Jean Ho
- Division of Cardiology, Weill Cornell Medicine, New York-Presbyterian Brooklyn Hospital, Brooklyn, New York, USA
| | - Igor Klem
- Division of Cardiology, Weill Cornell Medicine, New York-Presbyterian Brooklyn Hospital, Brooklyn, New York, USA
| | - Jaspal Singh
- Division of Cardiology, Weill Cornell Medicine, New York-Presbyterian Brooklyn Hospital, Brooklyn, New York, USA
| | - Berhane Worku
- Division of Cardiology, Weill Cornell Medicine, New York-Presbyterian Brooklyn Hospital, Brooklyn, New York, USA
| | - Robert F Tranbaugh
- Division of Cardiology, Weill Cornell Medicine, New York-Presbyterian Brooklyn Hospital, Brooklyn, New York, USA
| | - Terrence J Sacchi
- Division of Cardiology, Weill Cornell Medicine, New York-Presbyterian Brooklyn Hospital, Brooklyn, New York, USA
| | - John F Heitner
- Division of Cardiology, Weill Cornell Medicine, New York-Presbyterian Brooklyn Hospital, Brooklyn, New York, USA.
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Narayan P, Mandal CK, Das R, Das D, Ghorai PA, Chowdhury SR, Das M. Atrial fibrillation - Can HbA1c levels really predict the risk? Asian Cardiovasc Thorac Ann 2021; 30:141-146. [PMID: 33653152 DOI: 10.1177/0218492321998933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Diabetes is associated with higher mortality and worse post-operative outcomes in patients undergoing coronary artery bypass grafting and HbA1c levels have consistently been reported to be associated with adverse post-operative outcomes. However, the role of HbA1c still remains unclear with regards to the occurrence of atrial fibrillation. METHOD Data for the patients undergoing off-pump coronary artery bypass grafting was analysed in a retrospective fashion. Patients were divided into-those with HbA1c < 6.5% and those with HbA1c ≥ 6.5% and the incidence of atrial fibrillation observed in these two groups. We also compared patient who developed atrial fibrillation in the post-operative period and compared them with those who did not. RESULTS Of the 5259 patients included in the study HbA1c was <6.5 in 2808 (53.4%) patients and was ≥6.5 in 2451 (46.6%) patients; 623 (11.8%) patients in our study developed atrial fibrillation. Onset of atrial fibrillation in the post-operative period was seen most commonly 235 (38.3%) on between 24 and 48 h after the operation with more than half of them 338 (54.2%) occurring within the first 48 h. On multivariate analysis, HbA1c was not a risk factor for atrial fibrillation (odd's ratio 1.144, 95% confidence interval 0.967-1.354). Only increased age (odd's ratio 1.08; 95% confidence interval 1.069-1.091); EuroSCORE (odd's ratio 1.073; 95% confidence interval 1.048-1.099); history of recent MI (odd's ratio 0.768; 95% confidence interval 0.606-0.971) and peripheral vascular disease (odd's ratio 1.667; 95% confidence interval 1.091-2.517) were found to be independently associated with increased risk of atrial fibrillation in the post-operative period. CONCLUSIONS After adjusting for confounders HbA1c levels do not independently predict risk of atrial fibrillation after off-pump coronary artery bypass grafting.
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Affiliation(s)
- Pradeep Narayan
- Department of Cardiac Surgery, NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - Chandan Kumar Mandal
- Department of Anesthesia and Critical Care, NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - Rajlakshmi Das
- Department of Anesthesia and Critical Care, NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - Debasis Das
- Department of Cardiac Surgery, NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - Paramita Auddya Ghorai
- Department of Bio-Statistics, NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - Saibal Roy Chowdhury
- Department of Anesthesia and Critical Care, NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - Mrinalendu Das
- Department of Cardiac Surgery, NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
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Does ablation of atrial fibrillation at the time of septal myectomy improve survival of patients with obstructive hypertrophic cardiomyopathy? J Thorac Cardiovasc Surg 2021; 161:997-1006.e3. [DOI: 10.1016/j.jtcvs.2020.08.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/29/2020] [Accepted: 08/19/2020] [Indexed: 11/19/2022]
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3078] [Impact Index Per Article: 1026.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Shawwa K, Kompotiatis P, Bobart SA, Mara KC, Wiley BM, Jentzer JC, Kashani KB. New-onset atrial fibrillation in patients with acute kidney injury on continuous renal replacement therapy. J Crit Care 2020; 62:157-163. [PMID: 33383309 DOI: 10.1016/j.jcrc.2020.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/21/2020] [Accepted: 12/11/2020] [Indexed: 02/09/2023]
Abstract
PURPOSE The mortality of critically ill patients with acute kidney injury (AKI) who require continuous renal replacement therapy (CRRT) remains high. We assessed the incidence and predictors of new-onset atrial fibrillation (NOAF) in this population and its impact on outcomes. MATERIALS AND METHODS This is a retrospective cohort study of adult intensive care units (ICU) patients who had AKI and received CRRT from December 2006 through November 2015 in a tertiary academic medical center. Cox proportional hazard model was used to evaluate the impact of NOAF on overall mortality. RESULTS Out of 1398 screened patients, NOAF occurred in 193 (14%) cases. NOAF occurring on CRRT was independently associated with an increased hazard of death at follow-up (HR: 1.26; 95% CI: 1.03-1.56), compared to the group who did not have NOAF. In the multivariable analysis using time-dependent covariates, higher potassium (HR 1.24, 95%CI: 1.01-1.54) and bicarbonate (HR 0.95, 95%CI: 0.92-0.98) levels were associated with increased and decreased risk of NOAF on CRRT, respectively. CONCLUSIONS NOAF in critically ill patients with AKI receiving CRRT is common and carries an unfavorable prognosis. Prospective studies are required to elucidate modifiable risk factors for NOAF occurring on CRRT.
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Affiliation(s)
- Khaled Shawwa
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Panagiotis Kompotiatis
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shane A Bobart
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kristin C Mara
- Department of Health Science Research, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Brandon M Wiley
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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Taha A, Nielsen SJ, Bergfeldt L, Ahlsson A, Friberg L, Björck S, Franzén S, Jeppsson A. New-Onset Atrial Fibrillation After Coronary Artery Bypass Grafting and Long-Term Outcome: A Population-Based Nationwide Study From the SWEDEHEART Registry. J Am Heart Assoc 2020; 10:e017966. [PMID: 33251914 PMCID: PMC7955471 DOI: 10.1161/jaha.120.017966] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background The long‐term impact of new‐onset postoperative atrial fibrillation (POAF) after coronary artery bypass grafting and the benefit of early‐initiated oral anticoagulation (OAC) in patients with POAF are uncertain. Methods and Results All patients who underwent coronary artery bypass grafting without preoperative atrial fibrillation in Sweden from 2007 to 2015 were included in a population‐based study using data from 4 national registries: SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence‐based Care in Heart Disease Evaluated According to Recommended Therapies), National Patient Registry, Dispensed Drug Registry, and Cause of Death Registry. POAF was defined as any new‐onset atrial fibrillation during the first 30 postoperative days. Cox regression models (adjusted for age, sex, comorbidity, and medication) were used to assess long‐term outcome in patients with and without POAF, and potential associations between early‐initiated OAC and outcome. In a cohort of 24 523 patients with coronary artery bypass grafting, POAF occurred in 7368 patients (30.0%), and 1770 (24.0%) of them were prescribed OAC within 30 days after surgery. During follow‐up (median 4.5 years, range 0‒9 years), POAF was associated with increased risk of ischemic stroke (adjusted hazard ratio [aHR] 1.18 [95% CI, 1.05‒1.32]), any thromboembolism (ischemic stroke, transient ischemic attack, or peripheral arterial embolism) (aHR 1.16, 1.05‒1.28), heart failure hospitalization (aHR 1.35, 1.21‒1.51), and recurrent atrial fibrillation (aHR 4.16, 3.76‒4.60), but not with all‐cause mortality (aHR 1.08, 0.98‒1.18). Early initiation of OAC was not associated with reduced risk of ischemic stroke or any thromboembolism but with increased risk for major bleeding (aHR 1.40, 1.08‒1.82). Conclusions POAF after coronary artery bypass grafting is associated with negative prognostic impact. The role of early OAC therapy remains unclear. Studies aiming at reducing the occurrence of POAF and its consequences are warranted.
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Affiliation(s)
- Amar Taha
- Department of Molecular and Clinical Medicine Institute of Medicine Sahlgrenska AcademyUniversity of Gothenburg Sweden.,Department of Cardiology Region Västra GötalandSahlgrenska University Hospital Gothenburg Sweden
| | - Susanne J Nielsen
- Department of Molecular and Clinical Medicine Institute of Medicine Sahlgrenska AcademyUniversity of Gothenburg Sweden.,Department of Cardiothoracic Surgery Region Västra GötalandSahlgrenska University Hospital Gothenburg Sweden
| | - Lennart Bergfeldt
- Department of Molecular and Clinical Medicine Institute of Medicine Sahlgrenska AcademyUniversity of Gothenburg Sweden.,Department of Cardiology Region Västra GötalandSahlgrenska University Hospital Gothenburg Sweden
| | - Anders Ahlsson
- Department of Cardiothoracic Surgery Karolinska University Hospital Stockholm Sweden
| | - Leif Friberg
- Department of Clinical Sciences Karolinska Institute at Danderyd Hospital Stockholm Sweden
| | - Staffan Björck
- Centre for Registries Region Västra Götaland Gothenburg Sweden
| | - Stefan Franzén
- Centre for Registries Region Västra Götaland Gothenburg Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine Institute of Medicine Sahlgrenska AcademyUniversity of Gothenburg Sweden.,Department of Cardiothoracic Surgery Region Västra GötalandSahlgrenska University Hospital Gothenburg Sweden
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Riad FS, German K, Deitz S, Sahadevan J, Sundaram V, Waldo AL. Attitudes toward anticoagulation for postoperative atrial fibrillation: A nationwide survey of VA providers. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:1295-1301. [DOI: 10.1111/pace.14095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/04/2020] [Accepted: 10/18/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Fady S. Riad
- Harrington Heart and Vascular Institute University Hospitals and Case Western Reserve University Cleveland Ohio
| | - Konstantin German
- Harrington Heart and Vascular Institute University Hospitals and Case Western Reserve University Cleveland Ohio
| | - Sarah Deitz
- Harrington Heart and Vascular Institute University Hospitals and Case Western Reserve University Cleveland Ohio
| | - Jayakumar Sahadevan
- Harrington Heart and Vascular Institute University Hospitals and Case Western Reserve University Cleveland Ohio
- Department of Medicine Louis Stokes Veteran Affairs Medical Center Cleveland Ohio
| | - Varun Sundaram
- Harrington Heart and Vascular Institute University Hospitals and Case Western Reserve University Cleveland Ohio
- Department of Medicine Louis Stokes Veteran Affairs Medical Center Cleveland Ohio
| | - Albert L. Waldo
- Harrington Heart and Vascular Institute University Hospitals and Case Western Reserve University Cleveland Ohio
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Kerwin M, Saado J, Pan J, Ailawadi G, Mazimba S, Salerno M, Mehta N. New-onset atrial fibrillation and outcomes following isolated coronary artery bypass surgery: A systematic review and meta-analysis. Clin Cardiol 2020; 43:928-934. [PMID: 32696468 PMCID: PMC7462196 DOI: 10.1002/clc.23414] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/29/2020] [Accepted: 06/06/2020] [Indexed: 01/25/2023] Open
Abstract
Prior meta‐analyses have shown that new‐onset atrial fibrillation (NOAF) occurs in up to 40% of patients following cardiac surgery and is associated with substantial major adverse cardiovascular events. The stroke and mortality implications of NOAF in isolated CABG without concomitant valve surgery is not known. We thought that NOAF would be associated with increased risk of stroke and mortality, even in patients undergoing isolated CABG. A blinded review of studies from MEDLINE, CENTRAL, and Web of Science was done by two independent investigators. Stroke, 30‐day/hospital mortality, long‐term cardiovascular mortality, and long‐term (>1 year) all‐cause mortality were analyzed. We used Review Manager Version 5.3 to perform pooled analysis of outcomes. Of 4461 studies identified, 19 studies (n = 129 628) met inclusion criteria. NOAF incidence ranged from 15% to 36%. NOAF was associated with increased risk of stroke (unadjusted OR 2.15 [1.82, 2.53] [P < .00001]; adjusted OR 1.88 [1.02, 3.46] [P = .04]). NOAF was associated with increased 30‐day/hospital mortality (OR 2.35 [1.67, 3.32] [P < .00001]) and long‐term cardiovascular mortality (OR 2.04 [1.35, 3.09] [P = .0007]) NOAF was associated with increased long‐term all‐cause mortality (unadjusted OR 1.79 [1.63, 1.96] [P < .00001]; adjusted OR 1.58 [1.24, 2.00] [P = .0002]). We found that the incidence of NOAF following isolated CABG is high and is associated with increased stroke rate and mortality. Early recognition and management of NOAF could improve outcomes.
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Affiliation(s)
- Matthew Kerwin
- Division of Internal Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Jonathan Saado
- Division of Internal Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Jonathan Pan
- Division of Internal Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Gorav Ailawadi
- Division of Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Sula Mazimba
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Michael Salerno
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Nishaki Mehta
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA.,Division of Cardiovascular Medicine, William Beaumont Oakland University, Royal Oak, MI, USA
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Eikelboom R, Sanjanwala R, Le ML, Yamashita MH, Arora RC. Postoperative Atrial Fibrillation After Cardiac Surgery: A Systematic Review and Meta-Analysis. Ann Thorac Surg 2020; 111:544-554. [PMID: 32687821 DOI: 10.1016/j.athoracsur.2020.05.104] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 04/09/2020] [Accepted: 05/11/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Postoperative atrial fibrillation (POAF) after cardiac surgery is associated with longer hospital stay and increased in-hospital death and stroke, but its long-term implications remain incompletely understood. A systematic literature review was undertaken to investigate the impact of POAF on long-term death and stroke in adult patients who undergo cardiac operations. METHODS Electronic databases (Cochrane, Embase, Ovid MEDLINE, and PubMed) were queried from inception to October 2018. Included studies compared long-term outcomes after cardiac operations in patients with and without POAF. Adjusted and unadjusted meta-analyses examined death, stroke, and major adverse cardiac and cerebrovascular events. Risk of bias was evaluated with the Newcastle-Ottawa Scale. RESULTS The inclusion criteria were met by 32 studies describing 155,575 patients who had undergone cardiac operations. POAF occurred in 36,988 patients (23.7%). Meta-analysis of 10 studies (44,367 patients) demonstrated increased 1-year death in patients with POAF (odds ratio, 2.60; 95% confidence interval, 2-3.38; P < .01). Aggregate adjusted hazard of death (16 studies, n = 84,295) was also increased in patients with POAF (hazard ratio, 1.25; 95% confidence interval, 1.2-1.3; P < .01). CONCLUSIONS This systematic review and meta-analysis identified an association between POAF and long-term death after cardiac surgery. More comprehensive POAF prevention and management, including more stringent follow-up for POAF recurrence after hospital discharge, may be indicated. The included studies used inconsistent definitions of POAF and variable exclusion criteria; however, estimates of heterogeneity are low. Differences in preoperative comorbidities, such as age, ejection fraction, and obesity, may not be fully accounted for in adjusted analyses. Future work is required to delineate mechanisms linking POAF and death in this population.
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Affiliation(s)
- Rachel Eikelboom
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Rohan Sanjanwala
- Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Me-Linh Le
- Libraries, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael H Yamashita
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada; Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, Manitoba, Canada
| | - Rakesh C Arora
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada; Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, Manitoba, Canada.
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Skaria R, Parvaneh S, Zhou S, Kim J, Wanjiru S, Devers G, Konhilas J, Khalpey Z. Path to precision: prevention of post-operative atrial fibrillation. J Thorac Dis 2020; 12:2735-2746. [PMID: 32642182 PMCID: PMC7330352 DOI: 10.21037/jtd-19-3875] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Development of post-operative atrial fibrillation (POAF) following open-heart surgery is a significant clinical and economic burden. Despite advancements in medical therapies, the incidence of POAF remains elevated at 25-40%. Early work focused on detecting arrhythmias from electrocardiograms as well as identifying pre-operative risk factors from medical records. However, further progress has been stagnant, and a deeper understanding of pathogenesis and significant influences is warranted. With the advent of more complex machine learning (ML) algorithms and high-throughput sequencing, we have an unprecedented ability to capture and predict POAF in real-time. Integration of multimodal heterogeneous data and application of ML can generate a paradigm shift for diagnosis and treatment. This will require a concerted effort to consolidate and streamline real-time data. Herein, we will review the current literature and emerging opportunities aimed at predictive targets and new insights into the mechanisms underlying long-term sequelae of POAF.
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Affiliation(s)
- Rinku Skaria
- University of Arizona, College of Medicine, Tucson, AZ, USA
| | | | - Sophia Zhou
- Philips Research North America, Cambridge, MA, USA
| | - James Kim
- University of Arizona, College of Medicine, Tucson, AZ, USA
| | | | | | - John Konhilas
- University of Arizona, College of Medicine, Tucson, AZ, USA
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Kim SH, Hwang HY, Choi JW, Jang MJ, Kim KH, Kim KB. The impact of beta-blocker use on postoperative atrial fibrillation after aortic valve replacement. J Thorac Dis 2020; 12:2545-2552. [PMID: 32642162 PMCID: PMC7330287 DOI: 10.21037/jtd.2020.03.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background Current guidelines recommend perioperative use of beta-blocker (BB) in patients undergoing cardiac surgery to prevent postoperative atrial fibrillation (POAF). However, this recommendation is mainly based on studies those exclusively enrolled patients undergoing coronary artery bypass grafting. This study was conducted to evaluate the impact of perioperative BB use on the occurrence of POAF after aortic valve replacement (AVR). Methods From January 2015 to June 2018, 296 patients (male: female = 163:133) who underwent AVR at our institution were retrospectively reviewed. Patients who underwent concomitant valve surgery other than AVR or patients with preoperative arrhythmia were excluded. Mean age at the operation was 67±12 years. All patients were continuously tele-monitored for the occurrence of AF until discharge. Occurrence of any short runs of AF during the hospital stay was treated as POAF. Early outcomes were evaluated and perioperative factors associated with POAF were analyzed using a multivariable logistic regression model. Results Early mortality rate was 3.7% (11 of 296 patients). The POAF occurred in 154 patients (52.0%). Univariate analyses demonstrated that postoperative use of BB as well as age, type of prosthesis, history of stroke, body surface area, and chronic kidney disease were associated with the occurrence of POAF. The multivariable model showed that postoperative use of BB within 24 hours after AVR was a preventive factor of POAF (odds ratio, 0.354; 95% CI, 0.163 to 0.770; P=0.009). Conclusions Postoperative use of BB within 24 hours after AVR rather than preoperative use might be effective in prevention of POAF.
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Affiliation(s)
- Sue Hyun Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Myoung-Jin Jang
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ki-Bong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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50
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Higgs M, Sim J, Traynor V. Incidence and risk factors for new-onset atrial fibrillation following coronary artery bypass grafting: A systematic review and meta-analysis. Intensive Crit Care Nurs 2020; 60:102897. [PMID: 32601010 DOI: 10.1016/j.iccn.2020.102897] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/11/2020] [Accepted: 05/23/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To estimate the incidence of new-onset post-operative atrial fibrillation after isolated coronary artery bypass surgery and summarise the evidence on risk factors that predispose people to developing the complication. STUDY DESIGN/METHODS A systematic review was conducted to identify studies from the CINAHL, MEDLINE and Cochrane databases. A title and abstract review was conducted by one reviewer. Full text review and quality assessment processes were conducted by two reviewers. Incidence data was combined in meta-analysis using the 'metaprop' routine in Stata and risk factor data were synthesised in narrative and table format. RESULTS Ten studies, including 6173 participants, were included in the review. The estimated pooled incidence of post-operative atrial fibrillation was 25% (CI 0.19-0.30). In a secondary meta-analysis including studies that only included first time bypass surgery recipients the estimated pooled incidence was 26% (CI 0.14-0.41). Due to high levels of heterogeneity these results should be interpreted with caution. Risk factors with the strongest associations to post-operative atrial fibrillation were chronic obstructive pulmonary disease, decreased partial pressure of oxygen on air, congestive heart failure, right coronary artery disease, male gender, prolonged cross clamp time and port-operative inotropic exposure. CONCLUSION Further prospective studies are needed to strengthen the current evidence base.
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Affiliation(s)
- Megan Higgs
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.
| | - Jenny Sim
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Victoria Traynor
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
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