Prognostic impact of preoperative atrial fibrillation in patients undergoing heart surgery in cardiogenic shock
Authors: Kowalewski Mariusz , Raffa Giuseppe M. , Pasierski Michał , Kołodziejczak Michalina , Litwinowicz Radosław , Wańha Wojciech , Wojakowski Wojciech , Rogowski Jan , Jasiński Marek , Widenka Kazimierz , Hirnle Tomasz , Deja Marek , Bartus Krzysztof , Lorusso Roberto , Tobota Zdzisław , Maruszewski Bohdan , Suwalski Piotr ,   KROK Investigators, Anisimowicz Lech , Biederman Andrzej , Borkowski Dariusz , Brykczyński Mirosław , Bugajski Paweł , Burysz Marian , Cholewiński Paweł , Cichoń Romuald , Cisowski Marek , Dziatkowiak Antoni , Gburek Tadeusz , Gerber Witold , Gryszko Leszek , Haponiuk Ireneusz , Hendzel Piotr , Jabłonka Stanisław , Jarmoszewicz Krzysztof , Jaszewski Ryszard , Jemielity Marek , Kalawski Ryszard , Kapelak Bogusław , Karolczak Maciej A. , Kaperczak Jacek , Knapik Piotr , Krejca Michał , Kustrzycki Wojciech , Kuśmierczyk Mariusz , Kwinecki Paweł , Markuszewski Leszek , Missima Maurycy , Moll Jacek J. , Ogorzeja Wojciech , Pająk Jacek , Pasierski Michał , Pawliszak Wojciech , Pietrzyk Edward , Religa Grzegorz , Różański Jacek , Sadowski Jerzy , Sharma Girish , Skalski Janusz , Skiba Jacek , Stanisławski Ryszard , Stążka Janusz , Stec Sebastian , Stępiński Piotr , Suwalski Grzegorz , Suwalski Kazimierz , Tułecki Łukasz , Wierzba Waldemar , Wojtalik Michał , Woś Stanisław , Zembala Michał Oskar , Żelazny Piotr 
Published: December 2023

Surgical intervention in the setting of cardiogenic shock (CS) is burdened with high mortality. Due to acute condition, detailed diagnoses and risk assessment is often precluded. Atrial fibrillation (AF) is a risk factor for perioperative complications and worse survival but little is known about AF patients operated in CS. Current analysis aimed to determine prognostic impact of preoperative AF in patients undergoing heart surgery in CS. We analyzed data from the Polish National Registry of Cardiac Surgery (KROK) Procedures. Between 2012 and 2021, 332,109 patients underwent cardiac surgery in 37 centers; 4852 (1.5%) patients presented with CS. Of those 624 (13%) patients had AF history. Cox proportional hazards models were used for computations. Propensity score (nearest neighbor) matching for the comparison of patients with and without AF was performed. Median follow-up was 4.6 years (max.10.0), mean age was 62 (± 15) years and 68% patients were men. Thirty-day mortality was 36% (1728 patients). The origin of CS included acute myocardial infarction (1751 patients, 36%), acute aortic dissection (1075 patients, 22%) and valvular dysfunction (610 patients, 13%). In an unadjusted analysis, patients with underlying AF had almost 20% higher mortality risk (HR 1.19, 95% CIs 1.06–1.34; P = 0.004). Propensity score matching returned 597 pairs with similar baseline characteristics; AF remained a significant prognostic factor for worse survival (HR 1.19, 95% CI 1.00–1.40; P = 0.045). Among patients with CS referred for cardiac surgery, history of AF was a significant risk factor for mortality. Role of concomitant AF ablation and/or left atrial appendage occlusion or more aggressive perioperative circulatory support should be addressed in the future.