Prognostic Impact of Preoperative Atrial Fibrillation in Patients Undergoing Heart Surgery in Cardiogenic Shock
Prognostic Impact of Preoperative Atrial Fibrillation in Patients Undergoing Heart Surgery in Cardiogenic Shock
Abstract BackgroundSurgical intervention in the setting of cardiogenic shock (CS) is burdened with high mortality. Due to acute condition, detailed diagnoses and risk assessment is often precluded. Atrial fibrillation (AF) is a risk factor for perioperative complications and worse survival but little is known about AF patients operated in CS. Current analysis aimed to determine prognostic impact of preoperative AF in patients undergoing heart surgery in CS. MethodsWe analyzed data from the Polish National Registry of Cardiac Surgery (KROK) Procedures. Between 2012 and 2021, 4,852 patients presented with CS and were referred for cardiac surgery in 37 centers. Total of 624 (13%) patients had AF history. Cox proportional hazards models were used for computations. Propensity score (nearest neighbor) matching for the comparison of patients with and without AF was performed. ResultsMedian follow-up was 4.6 years (max.10.0), mean age was 62 (±15) years and 68% patients were men. Thirty-day mortality was 36%. The origin of CS included acute myocardial infarction (36%), acute aortic dissection (22%) and valvular dysfunction (13%). In an unadjusted analysis, patients with underlying AF had almost 20% higher mortality risk (HR 1.19, 95% CIs 1.06-1.34; P=0.004). Propensity score matching returned 597 pairs with similar baseline characteristics; AF remained a significant prognostic factor for worse survival (HR 1.19, 95% CI 1.00-1.40; P=0.045). ConclusionsAmong patients with CS referred for cardiac surgery, history of AF was a significant risk factor for mortality. Role of concomitant AF ablation and/or left atrial appendage occlusion should be addressed in the future.
Kowalewski Mariusz、Raffa Giuseppe M.、Pasierski Micha?、Pasierski Micha?、Wa¨?ha Wojciech、Wojakowski Wojciech、Rogowski Jan、Jasi¨?ski Marek、Tobota Zdzis?aw、Maruszewski Bohdan、Suwalski Piotr、Widenka Kazimierz、Ko?odziejczak Michalina、Hirnle Tomasz、Litwinowicz Rados?aw、Deja Marek、Bartus Krzysztof、Lorusso Roberto
Department of Cardiac Surgery and Transplantology, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education||Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre||Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus UniversityDepartment for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation||Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus UniversityDepartment of Cardiac Surgery and Transplantology, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education||Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus UniversityDepartment of Cardiac Surgery and Transplantology, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education||Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus UniversityDepartment of Cardiac Surgery, Medical University of Silesia, School of Medicine in Katowice||Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus UniversityDepartment of Cardiac Surgery, Medical University of Silesia, School of Medicine in KatowiceDepartment of Cardiac and Vascular Surgery, Medical University of GdanskDepartment and Clinic of Cardiac Surgery, Wroclaw Medical UniversityDepartment of Pediatric Cardiothoracic Surgery, The Children?ˉs Memorial Health InstituteDepartment of Pediatric Cardiothoracic Surgery, The Children?ˉs Memorial Health InstituteDepartment of Cardiac Surgery and Transplantology, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education||Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus UniversityClinical Department of Cardiac Surgery, District Hospital No. 2, University of Rzesz¨?wDepartment of Anaesthesiology and Intensive Care Nicolaus Copernicus University, Antoni Jurasz University Hospital No. 1||Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus UniversityDepartment of Cardiosurgery, Medical University of BialystokDepartment of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital||Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus UniversityDepartment of Cardiac Surgery, Upper-Silesian Heart Center||Department of Cardiology and Structural Heart Diseases, Medical University of SilesiaDepartment of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II HospitalCardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre
临床医学内科学
Cardiogenic ShockHeart surgeryAtrial fibrillationMortalityCABG
Kowalewski Mariusz,Raffa Giuseppe M.,Pasierski Micha?,Pasierski Micha?,Wa¨?ha Wojciech,Wojakowski Wojciech,Rogowski Jan,Jasi¨?ski Marek,Tobota Zdzis?aw,Maruszewski Bohdan,Suwalski Piotr,Widenka Kazimierz,Ko?odziejczak Michalina,Hirnle Tomasz,Litwinowicz Rados?aw,Deja Marek,Bartus Krzysztof,Lorusso Roberto.Prognostic Impact of Preoperative Atrial Fibrillation in Patients Undergoing Heart Surgery in Cardiogenic Shock[EB/OL].(2025-03-28)[2025-05-02].https://www.medrxiv.org/content/10.1101/2023.06.15.23291469.点此复制
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