Abstract 18119: Post-Operative Atrial Fibrillation after Coronary Artery Bypass Graft Surgery and Stroke Risk: a Systematic Review and Meta-Analysis
Introduction: New-onset post-operative atrial fibrillation (AF) occurs in nearly 20% of patients undergoing coronary artery bypass graft surgery (CABG). Though, most studies supported the association between AF and incident stroke in patients undergoing CABG, some refuted it. A systematic review of this topic is unavailable in the literature.
Hypothesis: We systematically reviewed the literature and pooled evidence that has associated AF and incident stroke in patients undergoing CABG.
Methods: Medline, Embase, Cochrane central library, and electronic databases were searched for relevant studies in all languages and without time restriction. Studies were included if: 1) they studied patients undergoing CABG, 2) reported rates of AF post-CABG and 3) reported rates of incident stroke. We excluded studies in which participants underwent concomitant valve surgeries and CABG.
Results: From a total of 3176 retrieved citations, 13 observational studies were included representing 86,537 CABGs. Of these 23,259 developed AF and 63,278 remained in sinus rhythm (SR). Stroke occurred in 1079 (4.6%) of the 23,259 patients with AF and in 2038 (3.2%) of the 63,278 patients with SR. In the pooled analysis, AF significantly increased stroke risk post CABG [risk ratio (RR): 2.36, 95% CI: 1.81 - 3.06, P < 0.001, I2: 88%, 13 included studies)]. The association between AF and incident stroke remained robust in a sensitivity analysis restricted to studies prior to 2006 (RR: 3.72, 95% CI: 1.61 - 8.63, P = 0.02, I2: 83%, 4 included studies) and post 2006 (RR: 2.11, 95% CI: 1.57 - 2.83, P < 0.001, I2: 89%, 9 included studies) (arbitrary dichotomization to account for temporal trends in advancement in post cardiac surgery care). Factors namely; age, gender, diabetes diagnosis, hypertension diagnosis, aspirin use, and statin use did not account for between study heterogeneity.
Conclusions: AF is strongly associated with risk of stroke post CABG even in the era of defined guidelines for anticoagulation in patients with post-operative AF. Refinement of risk stratification tools and revised strategies for long term anticoagulation are needed to effectively reduce stroke risk in this population.
Author Disclosures: G. Palamaner Subash Shantha: None. D. Pancholy: None. S.B. Pancholy: Research Grant; Modest; Accumed Radial Systems Inc.. Speakers Bureau; Modest; Pfizer, Medtronic. Consultant/Advisory Board; Modest; Terumo.
- © 2014 by American Heart Association, Inc.