Abstract 15624: Surgery Characteristic and Incidence of Post-operative Atrial Fibrillation, In-hospital Major Adverse Cardiovascular Event (MACE), and Mortality in the OPERATrial
Background: Postoperative atrial fibrillation (PoAF) complicates about 1/3rd of the cases of cardiac surgery and it has been associated with major adverse consequences. However, there is very scant data on how the various surgery characteristics contribute to the risk of PoAF and other clinical outcomes. We therefore set out to address this important gap in knowledge.
Methods: This study was conducted using the prospectively-collected data of the OPERA trial involving 1516 patients undergoing cardiac surgery across 28 centers in the US, Italy and Argentina. Surgery characteristics evaluated include type of surgery, mini thoracotomy, cardiopulmonary bypass, pump use, cardioplegia use, and method of rhythm return. Endpoints included the occurrence of PoAF, MACE, and mortality. Association between surgery characteristics and each endpoint was evaluated via multivariate logistic regression. In addition, we evaluated the impact of PoAF on resource utilization (including ICU and total hospital stay) and mortality.
Result: Mean (SD) age was 64 (13) years. There was significant trend (OR [95% CI]) across categories of surgery type (1.3 [1.0-1.4]), cardiopulmonary bypass use (2.4 [1.7-3.5]), off-pump vs on-pump (0.65 [0.44-0.96]), and cardioplegia use (2.3 [1.6-3.3]) with regards to the incidence of PoAF (Figure 1). However, only surgery type significantly predicts 30-day mortality (1.5 [1.0-2.2]) while spontaneous return of rhythm was associated with lower risk of MACE (0.47 [0.24-0.92]). PoAF was associated with increase resource utilization (p<0.001) and 1-year mortality (OR: 2.8 [95% CI, 1.4-5.4]).
Conclusion: In this multi-center clinical trial, we identified surgery characteristics that are associated with adverse clinical outcomes, especially PoAF. We believe this relatively novel information will facilitate adequate patient education/counseling, inform guideline for surgical practices, and identify procedures that will require PoAF prophylaxis.
Author Disclosures: E. Akintoye: None. F. Sellke: None. R. Marchioli: None. L. Tavazzi: None. D. Mozaffarian: Research Grant; Modest; The OPERA trial was supported by the NIH (1 RC2 HL101816) and GlaxoSmithKline, Sigma Tau, and Pronova BioPharma. Honoraria; Modest; Bunge, Haas Avocado Board, GOED, Amarin, Astra Zeneca, Boston Heart Diagnostics, and Life Sciences Research Organization. Consultant/Advisory Board; Modest; Unilever North America and Elysium Health.
- © 2016 by American Heart Association, Inc.