Yonsei Med J.  2017 Nov;58(6):1119-1127. 10.3349/ymj.2017.58.6.1119.

Gender Difference in the Long-Term Clinical Implications of New-Onset Atrial Fibrillation after Coronary Artery Bypass Grafting

• Lee SH
• Lee H
• Park JK
• Uhm JS
• Kim JY
• Pak HN
• Lee MH
• Yoon HG
• Joung B

• KMID: 2418893
• DOI: http://doi.org/10.3349/ymj.2017.58.6.1119

Abstract

PURPOSE
New-onset postoperative atrial fibrillation (POAF) is associated with poor short- and long-term outcomes after isolated coronary artery bypass graft (CABG) surgery. This study evaluated gender differences in the long-term clinical implications of POAF.
MATERIALS AND METHODS
After propensity score matching, a gender-based comparison of long-term (>1 year) newly developed atrial fibrillation (LTAF) and mortality between 1664 (480 females) consecutive patients with (POAF) and without POAF (no-POAF) who had undergone CABG was performed.
RESULTS
During a follow-up of 49±28 months, cumulative survival free of LTAF was lower in the POAF group than in the no-POAF group for both males (92.1% vs. 98.2%, p<0.001) and females (84.1% vs. 98.0%, p<0.001). However, female patients with POAF more frequently developed LTAF than male POAF patients (13.9 % vs. 6.9%, p=0.049). In multivariate analysis, POAF was a significant predictor of LTAF among males [hazard ratio (HR) 4.91; 95% confidence interval (CI) 1.22-19.79, p=0.031] and females (HR 16.50; 95% CI 4.79-56.78; p<0.001). POAF was a predictor of long-term mortality among females (adjusted HR 3.96; 95% CI 1.13-13.87, p=0.033), but not among males.
CONCLUSION
Although POAF was related to LTAF in both genders, cumulative survival free of LTAF was poorer among females than among males. Additionally, a significant correlation with long-term mortality after CABG was observed among female patients with POAF.

Keyword

Atrial fibrillation; coronary artery bypass graft; postoperative complications; survival; gender

MeSH Terms

Aged
Atrial Fibrillation/epidemiology/*etiology/mortality
Coronary Artery Bypass/*adverse effects/mortality
Coronary Artery Disease/*surgery
Female
Humans
Male
Middle Aged
Multivariate Analysis
Postoperative Complications/*epidemiology
Postoperative Period
Propensity Score
Proportional Hazards Models
Republic of Korea
Retrospective Studies
Sex Factors
Survival
Time Factors

Figure

• 

  Fig. 1 Flow diagram and follow-up for new-onset POAF, LTAF, and mortality. CABG, coronary artery bypass graft; AF, atrial fibrillation; POAF, postoperative atrial fibrillation; LTAF, long-term (>1 year) newly developed atrial fibrillation.

• 

  Fig. 2 Kaplan-Meier curves for survival free of LTAF according to the presence of POAF in the overall (A) and propensity score-matched patients (B). The left and right panels show the survival curves in the male and female patients according to POAF, respectively. The POAF group had a lower cumulative survival free of LTAF than the no-POAF group among both the overall and propensity score-matched patients (all p<0.001). The female POAF group had a lower cumulative survival free of LTAF than the male POAF group among the propensity score-matched patients (p=0.049). LTAF, long-term (>1 year) newly developed atrial fibrillation; POAF, postoperative atrial fibrillation; AF, atrial fibrillation.

• 

  Fig. 3 Kaplan-Meier curves for survival free of long-term mortality according to the presence of POAF in the overall (A) and propensity score-matched patients (B). The left and right panels show the survival curves in the male and female patients according to POAF, respectively. The POAF group had a lower cumulative survival free of long-term mortality than the no-POAF group among both the overall and propensity score-matched patients (all p<0.050). POAF, postoperative atrial fibrillation.

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