Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting

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Background: The impact of postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) on long-term clinical outcomes remains controversial.

Methods and Results: Of 14,927 consecutive patients with their first coronary revascularization in the CREDO-Kyoto Registry Cohort-3, we extracted data for 1,483 undergoing CABG without prior atrial fibrillation (AF). POAF was defined as newly documented AF during hospitalization for CABG and was diagnosed in 337 (23%) patients during the index hospitalization. The remaining 1,146 patients were categorized as the non-POAF group. The median follow-up after discharge was 5.7 years. The cumulative 5-year incidence of all-cause death did not differ significantly between the POAF and non-POAF groups (15.9% vs. 13.0%, respectively; P=0.38), whereas the cumulative 5-year incidence of stroke, heart failure, and Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding was significantly higher in the POAF group. There was no excess adjusted risk of the POAF group relative to the non-POAF group for all-cause death (hazard ratio 0.96; 95% confidence interval 0.70–1.31; P=0.81). The risk of the POAF group relative to the non-POAF group was numerically higher for stroke and heart failure, and significantly higher for BARC type 3 or 5 bleeding.

Conclusions: The long-term risk of patients with POAF relative to those without was significantly higher for major bleeding and numerically higher for stroke and heart failure, with no difference for mortality.