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Thorac Cardiovasc Surg 2018; 66(06): 483-490
DOI: 10.1055/s-0038-1629921
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Is There Any Difference in Risk Factors between Male and Female Patients in New-Onset Atrial Fibrillation after Coronary Artery Bypass Grafting?

Barış Akça
1   Department of Cardiovascular Surgery, Inonu Universitesi Tip Fakultesi, Malatya, Turkey
,
Nevzat Erdil
2   Department of Cardiovascular Surgery, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey
,
Mehmet Cengiz Colak
1   Department of Cardiovascular Surgery, Inonu Universitesi Tip Fakultesi, Malatya, Turkey
,
Olcay Murat Disli
1   Department of Cardiovascular Surgery, Inonu Universitesi Tip Fakultesi, Malatya, Turkey
,
Bektas Battaloglu
1   Department of Cardiovascular Surgery, Inonu Universitesi Tip Fakultesi, Malatya, Turkey
,
Cemil Colak
3   Department of Biostatistics, Inonu Universitesi Tip Fakultesi, Malatya, Turkey
› Author Affiliations
Further Information

Publication History

24 December 2017

12 January 2018

Publication Date:
06 March 2018 (online)

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Abstract

Background We aimed to investigate the risk factors of post-coronary artery bypass grafting (CABG) atrial fibrillation (AF) in male and female patients without any history of AF, to identify the sex-specific risk factors, and to examine the effect of sex-specific risk factors on the overall population.

Methods This retrospective study was conducted using the hospital database with 4,758 patients who underwent CABG surgery. Among them, 2,836 patients with complete data participated in this study. The female patients were divided into two groups as patients who developed new-onset AF after CABG and those who did not. The relationship between the patients' variables and risk factors of post-CABG AF was examined.

Results The overall incidence of post CABG AF was 12.9% (386/2,836). Sex-specific incidence of AF was similar: 3.2% (91/690) and 12.9% (277/2146) in female and male patients, respectively (p = 0.849). Multiple analysis revealed the independent risk factors for male and female patients, respectively: mean age (odds ratio [OR] = 1.057, OR = 1,076), age over 65 years (OR = 2.156, OR = 2.736), the European System For Cardiac Operative Risk Evaluation Scores (EuroSCORE) (OR = 1.13, OR = 1.218), COPD (OR = 1.589, OR = 1.789), BUN level (OR = 1.026, OR = 1.019), mean cardiopulmonary bypass (CPB) time (OR = 1.007, OR = 1.010), prolonged CPB time (OR = 1.604, OR = 2.309), mean cross-clamp time (OR = 1.009, OR = 1.017), need of inotropic support (OR = 2.249, OR = 2.731), and mean mechanical ventilation time (VT) (OR = 1.026, OR = 1.027).

Low left ventricular ejection fraction (LVEF) (OR = 1.419), left ventricular (LV) aneurysm repair (OR = 1.533), carotid artery disease (OR = 1.750), prolonged VT (OR = 1.729), and use of intra-aortic balloon pump (IABP) (OR = 2.436) were found to be the risk factors only for male AF patients.

Unstable angina (OR = 1.969), right coronary artery (RCA) disease (OR = 2), prolonged cross-clamp time (OR = 2.152), and the number of grafts per operation (OR = 1.298) were found to be the risk factors only for female AF patients.

Conclusion This study suggests that predictors of AF in the overall population may be due to isolated patient groups. Multiple regression analysis and artificial intelligence modelling should be performed on large-scale, isolated groups to make strong AF prediction.

Keywords

atrial fibrillation - coronary artery bypass grafting - risk factors - sex factors
 

  • References

  • 1 Erdem K, Yazıcı M, Öztürk S. , et al. Usefulness of CHA2DS2-VASc scoring system in predicting atrial fibrillation after coronary artery bypass grafting. Turk Gogus Kalp Dama 2016; 24 (01) 27-33
    CrossrefPubMedGoogle Scholar
  • 2 Kaireviciute D, Aidietis A, Lip GY. Atrial fibrillation following cardiac surgery: clinical features and preventative strategies. Eur Heart J 2009; 30 (04) 410-425
    PubMedGoogle Scholar
  • 3 Erdil N, Gedik E, Donmez K. , et al. Predictors of postoperative atrial fibrillation after on-pump coronary artery bypass grafting: is duration of mechanical ventilation time a risk factor?. Ann Thorac Cardiovasc Surg 2014; 20 (02) 135-142
    CrossrefPubMedGoogle Scholar
  • 4 El-Chami MF, Kilgo PD, Elfstrom KM. , et al. Prediction of new onset atrial fibrillation after cardiac revascularization surgery. Am J Cardiol 2012; 110 (05) 649-654
    CrossrefPubMedGoogle Scholar
  • 5 Mathew JP, Fontes ML, Tudor IC. , et al; Investigators of the Ischemia Research and Education Foundation; Multicenter Study of Perioperative Ischemia Research Group. A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA 2004; 291 (14) 1720-1729
    CrossrefPubMedGoogle Scholar
  • 6 Goksin I, Saçar M, Baltalarlı A. , et al. Determinants of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting: prophylactic beta-blocker plus statin therapy for prevention of postoperative atrial fibrillation. Turk Gogus Kalp Dama 2006; 14: 177-184
    PubMedGoogle Scholar
  • 7 Filardo G, Ailawadi G, Pollock BD. , et al. Sex differences in the epidemiology of new-onset in-hospital post-coronary artery bypass graft surgery atrial fibrillation: a large multicenter study. Circ Cardiovasc Qual Outcomes 2016; 9 (06) 723-730
    CrossrefPubMedGoogle Scholar
  • 8 Kokkonen L, Järvinen O, Majahalme S. , et al. Atrial fibrillation in elderly patients after coronary artery bypass grafting; gender differences in outcome. Scand Cardiovasc J 2005; 39 (05) 293-298
    CrossrefPubMedGoogle Scholar
  • 9 Funk M, Richards SB, Desjardins J, Bebon C, Wilcox H. Incidence, timing, symptoms, and risk factors for atrial fibrillation after cardiac surgery. Am J Crit Care 2003; 12 (05) 424-433 , quiz 434–435
    CrossrefPubMedGoogle Scholar
  • 10 Deliargyris EN, Raymond RJ, Guzzo JA. , et al. Preoperative factors predisposing to early postoperative atrial fibrillation after isolated coronary artery bypass grafting. Am J Cardiol 2000; 85 (06) 763-764 , A8
    CrossrefPubMedGoogle Scholar
  • 11 Jideus L, Blomstrom P, Nilsson L, Stridsberg M, Hansell P, Blomström-Lundqvist C. Tachyarrhythmias and triggering factors for atrial fibrillation after coronary artery bypass operation. Ann Thorac Surg 2000; 69 (04) 1064-1069
    CrossrefPubMedGoogle Scholar
  • 12 Mayr A, Knotzer H, Pajk W. , et al. Risk factors associated with new onset tachyarrhythmias after cardiac surgery--a retrospective analysis. Acta Anaesthesiol Scand 2001; 45 (05) 543-549
    PubMedGoogle Scholar
  • 13 Passman R, Beshai J, Pavri B, Kimmel S. Predicting post-coronary bypass surgery atrial arrhythmias from the preoperative electrocardiogram. Am Heart J 2001; 142 (05) 806-810
    CrossrefPubMedGoogle Scholar
  • 14 Skubas NJ, Barzilai B, Hogue Jr CW. Atrial fibrillation after coronary artery bypass graft surgery is unrelated to cardiac abnormalities detected by transesophageal echocardiography. Anesth Analg 2001; 93 (01) 14-19
    PubMedGoogle Scholar
  • 15 Nisanoglu V, Erdil N, Aldemir M. , et al. Atrial fibrillation after coronary artery bypass grafting in elderly patients: incidence and risk factor analysis. Thorac Cardiovasc Surg 2007; 55 (01) 32-38
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Hravnak M, Hoffman LA, Saul MI, Zullo TG, Whitman GR, Griffith BP. Predictors and impact of atrial fibrillation after isolated coronary artery bypass grafting. Crit Care Med 2002; 30 (02) 330-337
    CrossrefPubMedGoogle Scholar
  • 17 Albahrani MJ, Swaminathan M, Phillips-Bute B. , et al. Postcardiac surgery complications: association of acute renal dysfunction and atrial fibrillation. Anesth Analg 2003; 96 (03) 637-643
    PubMedGoogle Scholar
  • 18 Creswell LL. Postoperative atrial arrhythmias: risk factors and associated adverse outcomes. Semin Thorac Cardiovasc Surg 1999; 11 (04) 303-307
    CrossrefPubMedGoogle Scholar
  • 19 Hakala T, Hedman A. Predicting the risk of atrial fibrillation after coronary artery bypass surgery. Scand Cardiovasc J 2003; 37 (06) 309-315
    CrossrefPubMedGoogle Scholar
  • 20 Creswell LL, Schuessler RB, Rosenbloom M, Cox JL. Hazards of postoperative atrial arrhythmias. Ann Thorac Surg 1993; 56 (03) 539-549
    CrossrefPubMedGoogle Scholar
  • 21 Almassi GH, Schowalter T, Nicolosi AC. , et al. Atrial fibrillation after cardiac surgery: a major morbid event?. Ann Surg 1997; 226 (04) 501-511 , discussion 511–513
    CrossrefPubMedGoogle Scholar
  • 22 Ad N, Snir E, Vidne BA, Golomb E. Potential preoperative markers for the risk of developing atrial fibrillation after cardiac surgery. Semin Thorac Cardiovasc Surg 1999; 11 (04) 308-313
    CrossrefPubMedGoogle Scholar
  • 23 Mathew JP, Parks R, Savino JS. , et al. Atrial fibrillation following coronary artery bypass graft surgery: predictors, outcomes, and resource utilization. MultiCenter Study of Perioperative Ischemia Research Group. JAMA 1996; 276 (04) 300-306
    CrossrefPubMedGoogle Scholar
  • 24 Mahoney EM, Thompson TD, Veledar E, Williams J, Weintraub WS. Cost-effectiveness of targeting patients undergoing cardiac surgery for therapy with intravenous amiodarone to prevent atrial fibrillation. J Am Coll Cardiol 2002; 40 (04) 737-745
    CrossrefPubMedGoogle Scholar
  • 25 Caretta Q, Mercanti CA, De Nardo D. , et al. Ventricular conduction defects and atrial fibrillation after coronary artery bypass grafting. Multivariate analysis of preoperative, intraoperative and postoperative variables. Eur Heart J 1991; 12 (10) 1107-1111
    CrossrefPubMedGoogle Scholar
  • 26 Fuller JA, Adams GG, Buxton B. Atrial fibrillation after coronary artery bypass grafting. Is it a disorder of the elderly?. J Thorac Cardiovasc Surg 1989; 97 (06) 821-825
    CrossrefPubMedGoogle Scholar
  • 27 Hashimoto K, Ilstrup DM, Schaff HV. Influence of clinical and hemodynamic variables on risk of supraventricular tachycardia after coronary artery bypass. J Thorac Cardiovasc Surg 1991; 101 (01) 56-65
    CrossrefPubMedGoogle Scholar
  • 28 Aranki SF, Shaw DP, Adams DH. , et al. Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resources. Circulation 1996; 94 (03) 390-397
    CrossrefPubMedGoogle Scholar
  • 29 Ismail MF, El-Mahrouk AF, Hamouda TH, Radwan H, Haneef A, Jamjoom AA. Factors influencing postoperative atrial fibrillation in patients undergoing on-pump coronary artery bypass grafting, single center experience. J Cardiothorac Surg 2017; 12 (01) 40
    CrossrefPubMedGoogle Scholar
  • 30 Mendes LA, Connelly GP, McKenney PA. , et al. Right coronary artery stenosis: an independent predictor of atrial fibrillation after coronary artery bypass surgery. J Am Coll Cardiol 1995; 25 (01) 198-202
    CrossrefPubMedGoogle Scholar