The Impact of Postoperative Atrial Fibrillation and Race on Long-Term Survival after Coronary Artery Bypass Grafting

Authors

  • Wesley T. O'Neal M.D.,

    Corresponding author
    • Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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  • Jimmy T. Efird Ph.D., M.Sc.,

    1. Department of Cardiovascular Sciences, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, North Carolina
    2. Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, North Carolina
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  • Stephen W. Davies M.D.,

    1. Department of General Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
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  • Jason B. O'Neal M.D.,

    1. Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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  • Curtis A. Anderson M.D.,

    1. Department of Cardiovascular Sciences, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, North Carolina
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  • T. Bruce Ferguson M.D.,

    1. Department of Cardiovascular Sciences, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, North Carolina
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  • W. Randolph Chitwood M.D.,

    1. Department of Cardiovascular Sciences, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, North Carolina
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  • Alan P. Kypson M.D.

    1. Department of Cardiovascular Sciences, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, North Carolina
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  • Conflict of interest: The authors acknowledge no conflict of interest in the submission.

Address for correspondence: Wesley T. O'Neal, M.D., Wake Forest University School of Medicine, Department of Internal Medicine, Medical Center Boulevard, Winston-Salem, NC 27517. Fax: +1-336-716-2273; e-mail: woneal@wakehealth.edu

Abstract

Background and Aim

Postoperative atrial fibrillation (POAF) is a known predictor of in-hospital morbidity and short-term survival after coronary artery bypass grafting (CABG). The impact of race and long-term survival has not been examined in this population. We aimed to examine the influence of these factors on long-term survival in patients undergoing CABG.

Methods

Patients undergoing first-time, isolated CABG between 1992 and 2011 were included in this study. Long-term survival was compared in patients with and without POAF and stratified by race. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model.

Results

A total of 2,907 (22%) patients developed POAF (black n = 370; white n = 2,537) following CABG (N = 13,165). Median follow-up for study participants was 8.2 years. Long-term survival after CABG differed by POAF status and race (no POAF: HR = 1.0; white POAF: adjusted HR = 1.1, 95% CI = 1.06–1.2; black POAF: adjusted HR = 1.4, 95% CI = 1.2–1.6; pTrend = 0.0002). Black POAF patients also died sooner after surgery than their white counterparts (adjusted HR = 1.2, 95% CI = 1.02–1.4).

Conclusion

Black race was a statistically significant predictor of decreased survival among POAF patients after CABG. This finding provides useful outcome information for surgeons and their patients. doi: 10.1111/jocs.12178 (J Card Surg 2013;28:484–491)

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