부산대학교 도서관

Introduction:Post-coronary artery bypass grafting surgery (CABG) atrial fibrillation (AF) is associated with increased morbidity and mortality. Despite its high incidence and clinical importance, management of AF following CABG is not standardized. We sought to elucidate national practice patterns regarding anticoagulation and antiarrhythmic medication use at discharge and examine short-term patient outcomes.Methods:We analyzed patient data from the STS Adult Cardiac Surgery Database (ACSD) from July 2011-June 2018 who underwent first-time CABG with no valve procedure and developed new post-CABG AF without significant complication. We examined prescription rates of anticoagulation and amiodarone at discharge, as well as 30-day readmission rates for stroke or bleeding and 30-day mortality.Results:832,958 patients with no prior AF or stroke underwent isolated first-time CABG and 23.8% (n=198,244) developed new post-CABG AF. Of these, 166,747 patients met study criteria. 25.7% of patients were discharged on anticoagulation with an average CHA2DS2-VASc score of 3.2 +/-1.3. Anticoagulation use at discharge was not associated with lower 30-day stroke readmissions [Adjusted Odds Ratio (AOR) 0.87, 95% CI 0.65-1.16, p=0.35]. Adjusted 30-day readmissions for major bleeding were significantly more common in anticoagulated patients (AOR 4.30, 95%CI 3.69-5.03, p<.0001). Among those discharged off anticoagulation, there was no significant difference in adjusted 30-day stroke rates based on amiodarone use at discharge (AOR 1.19, 95% CI 0.85-1.66, p=0.31).Conclusions:Post-CABG anticoagulation for new AF is associated with increased bleeding and no difference in stroke at 30 days. Prospective randomized studies are needed to formalize safe and efficacious short- and long-term management strategies.