TY - JOUR
T1 - Total arterial revascularization coronary artery bypass surgery in patients with atrial fibrillation
AU - Pasierski, Michał
AU - Czarnecka, Karolina
AU - Staromłyński, Jakub
AU - Litwinowicz, Radosław
AU - Filip, Grzegorz
AU - Kowalówka, Adam
AU - Wańha, Wojciech
AU - Kołodziejczak, Michalina
AU - Piekuś-Słomka, Natalia
AU - Łoś, Andrzej
AU - Stefaniak, Sebastian
AU - Wojakowski, Wojciech
AU - Jemielity, Marek
AU - Rogowski, Jan
AU - Deja, Marek
AU - Jagielak, Dariusz
AU - Bartus, Krzysztof
AU - Mariani, Silvia
AU - Li, Tong
AU - Lorusso, Roberto
AU - Suwalski, Piotr
AU - Kowalewski, Mariusz
N1 - Publisher Copyright:
© Author(s), 2022.
PY - 2022/8/29
Y1 - 2022/8/29
N2 - Background: Atrial fibrillation (AF) is a relatively common comorbidity among patients referred for coronary artery bypass grafting (CABG) and is associated with poorer prognosis. However, little is known about how surgical technique influences survival in this population. Aim: The current analysis aimed to determine whether total arterial revascularization (TAR) is associated with improved long-term outcomes in patients with preoperative AF. Methods: We analyzed patients' data from the HEIST (HEart surgery In atrial fibrillation and Supraventricular Tachycardia) registry. The registry, to date, involves five tertiary high-volume centers in Poland. Between 2006 and 2019, 4746 patients presented with preoperative AF and multivessel coronary artery disease and underwent CABG. We identified cases of TAR and used propensity score matching to determine non-TAR controls. Median follow-up was 4.1 years (interquartile range [IQR], 1.9-6.8 years). Results: Propensity matching resulted in 295 pairs of TAR vs. non-TAR. The mean (standard deviation [SD]) number of distal anastomoses was 2.5 (0.6) vs. 2.5 (0.6) (P = 0.94), respectively. Operative and 30-day mortality was not different between TAR and non-TAR patients (hazard ratio [HR] and 95% confidence intervals [CIs], 0.17 (0.02-1.38); P = 0.12 and 0.74 [0.40-1.35]; P = 0.33, respectively). By contrast, TAR was associated with nearly 30% improved late survival: HR, 0.72 (0.55-0.93); P = 0.01. This benefit was sustained in subgroup analyses, yet most pronounced in low-risk patients (<70 years old; EuroSCORE II <2; no diabetes) and when off-pump CABG was performed. Conclusions: TAR in patients with preoperative AF is safe and associated with improved survival, with particular survival benefits in younger low-risk patients undergoing off-pump CABG.
AB - Background: Atrial fibrillation (AF) is a relatively common comorbidity among patients referred for coronary artery bypass grafting (CABG) and is associated with poorer prognosis. However, little is known about how surgical technique influences survival in this population. Aim: The current analysis aimed to determine whether total arterial revascularization (TAR) is associated with improved long-term outcomes in patients with preoperative AF. Methods: We analyzed patients' data from the HEIST (HEart surgery In atrial fibrillation and Supraventricular Tachycardia) registry. The registry, to date, involves five tertiary high-volume centers in Poland. Between 2006 and 2019, 4746 patients presented with preoperative AF and multivessel coronary artery disease and underwent CABG. We identified cases of TAR and used propensity score matching to determine non-TAR controls. Median follow-up was 4.1 years (interquartile range [IQR], 1.9-6.8 years). Results: Propensity matching resulted in 295 pairs of TAR vs. non-TAR. The mean (standard deviation [SD]) number of distal anastomoses was 2.5 (0.6) vs. 2.5 (0.6) (P = 0.94), respectively. Operative and 30-day mortality was not different between TAR and non-TAR patients (hazard ratio [HR] and 95% confidence intervals [CIs], 0.17 (0.02-1.38); P = 0.12 and 0.74 [0.40-1.35]; P = 0.33, respectively). By contrast, TAR was associated with nearly 30% improved late survival: HR, 0.72 (0.55-0.93); P = 0.01. This benefit was sustained in subgroup analyses, yet most pronounced in low-risk patients (<70 years old; EuroSCORE II <2; no diabetes) and when off-pump CABG was performed. Conclusions: TAR in patients with preoperative AF is safe and associated with improved survival, with particular survival benefits in younger low-risk patients undergoing off-pump CABG.
KW - Cabg
KW - Arterial grafts
KW - Atrial fibrillation
KW - Survival
KW - Total arterial revascularization
U2 - 10.33963/kp.a2022.0200
DO - 10.33963/kp.a2022.0200
M3 - Article
C2 - 36036747
SN - 0022-9032
VL - 80
SP - 1119
EP - 1126
JO - Kardiologia Polska
JF - Kardiologia Polska
IS - 11
ER -