Postoperative Atrial Fibrillation and Long-Term Risk of Stroke After Isolated Coronary Artery Bypass Graft Surgery
Authors: Benedetto Umberto , Gaudino Mario F. , Dimagli Arnaldo , Gerry Stephen , Gray Alastair , Lees Belinda , Flather Marcus , Taggart David P. , Westaby S. , Cook J. , Wallis C. , Wos S. , Jasinski M. , Widenka K. , Blach A. , Gocol R. , Hudziak D. , Zurek P. , Deja M. , Bachowski R. , Mrozek R. , Kargul T. , Domarardzki W. , Frackiewicz J. , Zamvar V. , Ezakadan D. , Buxton B. , Seevanayagam S. , Matalanis G. , Rosalion A. , Negri J. , Moten S. , Atkinson V. , Newcomb A. , Polidano P. , Pana R. , Gerbo S. , O’Keefe P. , von Oppell U. , Mehta D. , Azzu A. , Szafranek A. , Kulatilake E. , Evans J. , Martin N. , Banner D. , Trivedi U. , Forsyth A. , Hyde J. , Cohen A. , Lewis M. , Gardner E. , MacKenzie A. , Cooter N. , Joyce E. , Parker J. , Champney F. , Clark S. , Dark J. , Tocewicz K. , Pillay T. , Rowling S. , Adams-Hall J. , Bochenek A. , Cisowski M. , Bolkowski M. , Morawski W. , Guc M. , Krejca M. , Wilczynski M. , Duralek A. , Gerber W. , Skarysz J. , Shrestha R. , Swiech W. , Szmagala P. , Krzych L. , Pawlak A. , Kepa K. , Hasan R. , Keenan D. , Prendergast B. , Odom N. , McLaughlin K. , Cummings-Fosong G. , Mathew C. , Iles-Smith H. , Oomen A. , Desai J. , El-Gamel A. , John L. , Wendler O. , Andrews M. , Rance K. , Williams R. , Hogervorst V. , Gregory J. , Jessup J. , Knighton A. , Hoare A. , Ritchie A. , Choong C. , Nair S. , Jenkins D. , Large S. , Sudarshan C. , Barman M. , Dhital K. , Routledge T. , Rosengard B. , Munday H. , Rintoul K. , Jarrett E. , Lao-Sirieix S. , Wilkinson A. , Garner L. , Osmond J. , Holcombe H. , Cale A. , Griffin S. , Dickson J. , Cook J. , Spyt T. , Hickey M. , Sosnowski A. , Peek G. , Szostek J. , Hadjinikalaou L. , Logtens E. , Oakley M. , Leji S. , Gaer J. , Amrani M. , Dreyfus G. , Bahrami T. , Baig K. , Asimakopoulos G. , Vohra H. , Pai V. , Tadjkarimi, Soleimani S. , Stavri G. , Bull G. , Collappen H. , Sadowksi J. , Gaweda B. , Rudzinski P. , Stolinski J. , Konstanty-Kalandyk J. , Moraes F. , Moraes C. , Wanderley J. , Pepper J. , De Souza A. , Petrou M. , Trimlett R. , Morgan T. , Gavino J. , Wang S.F. , Chandrasekaran V. , Kanagasaby R. , Sarsam M. , Ryan H. , Billings L. , Ruddick L. , Achampong A. , Forster E. , Pawlaczyk R. , Siondalski P. , Rogowski J. , Roszak K. , Jarmoszewicz K. , Jagielak D. , Gafka S. , Mannam, Naguboyin G. , Rao Sajja L. , Dandu B. , Briffa N. , Braidley P. , Cooper G. , Knighton A. , Allen K. , Sangha G. , Bridge C. , McMellon H. , Casabona R. , Actis Dato G. , Bardi G. , Del Ponte, Forsennati S. , Parisi F. , Punta G. , Flocco R. , Sansone F. , Zingarelli E. , Dihmis W. , Kuduvali M. , Rince C. , Rogers H. , McQuade L. , Anisimowicz L. , Bokszanski M. , Pawliszak W. , Kolakowski J. , Lau G. , Ogorzeja W. , Gumanska I. , Kulinski P. , Podesser B. , Trescher K. , Bernecker O. , Holzinger C. , Binder K. , Schor I. , Bergmann P. , Kassal H. , Motovova B. , Trehan N. , Meharwal Z. , Malhotra R. , Goel M. , Kumer B. , Bazaz S. , Bake N. , Singh A. , Mishka Y. , Gupta R. , Basumatary S. , Zembala M. , Szafron B. , Pacholewicz J. , Krason M. , Widenka K. , Szymanik I. , Kolwca M. , Mazur W. , Kurowicki A. , Zurek S. , Stacel T. , Jaworska I. 
Published: October 2020

Background:
Postoperative atrial fibrillation (pAF) after coronary artery bypass grafting is a common complication. Whether pAF is associated with an increased risk of cerebrovascular accident (CVA) remains uncertain. We investigated the association between pAF and long-term risk of CVA by performing a post hoc analysis of 10-year outcomes of the ART (Arterial Revascularization Trial).

Methods:
For the present analysis, among patients enrolled in the ART (n=3102), we excluded those who did not undergo surgery (n=25), had a history of atrial fibrillation (n=45), or had no information on the incidence of pAF (n=9). The final population consisted of 3023 patients, of whom 734 (24.3%) developed pAF with the remaining 2289 maintaining sinus rhythm. Competing risk and Cox regression analyses were used to investigate the association between pAF and the risk of CVA.

Results:

At 10 years, the cumulative incidence of CVA was 6.3% (4.6%–8.1%) versus 3.7% (2.9%–4.5%) in patients with pAF and sinus rhythm, respectively. pAF was an independent predictor of CVA at 10 years (hazard ratio, 1.53 [95% CI, 1.06–2.23];
P
=0.025) even when CVAs that occurred during the index admission were excluded from the analysis (hazard ratio, 1.47 [95% 1.02–2.11];
P
=0.04).

Conclusions:
Patients with pAF after coronary artery bypass grafting are at higher risk of CVA. These findings challenge the notion that pAF is a benign complication.