Impact of atrial fibrillation on the risk of major adverse cardiac events following coronary revascularisation

• Type of Material: Article
• Authors: Richard G Jung, University of Ottawa Heart Institute; Omar Abdel-Razek, University of Ottawa Heart Institute; Pietro Di Santo, University of Ottawa Heart Institute; Taylor Gillmore, University of Ottawa; Cameron Stotts, University of Ottawa; Dwipen Makwana, University of Ottawa; Joelle Soriano, University of Ottawa; Robert Moreland, University of Ottawa Heart Institute; Louis Verreault-Julien, Emory University; Cheng Yee Goh, University of Ottawa Heart Institute; Simon Parlow, University of Ottawa Heart Institute; Caleb Sypkes, University of Ottawa; Daniel F Ramirez, University of Ottawa Heart Institute; Mouhannad Sadek, University of Ottawa Heart Institute; Vincent Chan, University of Ottawa Heart Institute; Hadi Toeg, University of Ottawa Heart Institute; Trevor Simard, Mayo Clinic, Rochester; Michael PV Froeschl, University of Ottawa Heart Institute; Marino Labinaz, University of Ottawa Heart Institute; Benjamin Hibbert, University of Ottawa Heart Institute
• Language: English
• Date: 2022-09-23
• Publisher: BMJ Publishing Group
• Publication Version: Final Published Version
• Copyright Statement: © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1136/openhrt-2022-002012
• Title of Journal or Parent Work: Open Heart
• Volume: 9
• Issue: 2
• Grant/Funding Information: RGJ was funded by the Vanier CIHR Canada Graduate Scholarship. The authors would like to thank all the collaborators and CAPITAL Research Group for all their support and guidance for the completion of the project.
• Keywords: CORONARY ARTERY DISEASE; Coronary Artery Bypass; Percutaneous Coronary Intervention; Atrial Fibrillation; Myocardial Infarction
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Objective Atrial fibrillation (AF) remains a highly prevalent arrhythmia with significant burden on morbidity and mortality. The impact of AF in the revascularised population remains incompletely described. Given the high prevalence of AF in the revascularised population, we sought to evaluate the incidence and prognosis in patients with pre-existing and new-onset AF following revascularisation. Methods We used the University of Ottawa Heart Institute Revascularisation Registry to identify patients who underwent revascularisation between August 2015 and March 2020, who were prospectively followed for an average of one year. We conducted a retrospective cohort study analysing the association between AF and clinical outcomes. The primary outcome of interest was 1-year major adverse cardiac events (MACE) defined as a composite of death, myocardial infarction, unplanned revascularisation and cerebrovascular accidents. Moreover, secondary outcomes include the individual components of MACE and bleeding. Results A total of 6704 patients underwent revascularisation and completed 1-year clinical follow-up. Median time to follow-up was 12.8 (IQR 11.2–15.9) months. One-year MACE occurred in 166 (21.8%) and 683 (11.5%) patients in AF and non-AF groups, respectively (adjusted HR, 1.61; 95% CI 1.29 to 2.01; p<0.0001). AF was independently predictive of 1-year mortality, myocardial infarction, unplanned revascularisation, cerebrovascular accident and bleeding. Within 1 year, 299 (4.5%) episodes of new-onset AF was observed. New-onset AF following revascularisation was also associated with 1-year MACE, mortality, myocardial infarction, cerebrovascular accident and unplanned revascularisation. Conclusions Preprocedural and new-onset AF following revascularisation remains highly predictive 1-year MACE. AF should be considered in addition to traditional risk factors for adverse outcomes following revascularisation.