Early postoperative atrial fibrillation is associated with late mortality after cardiac surgery: a systematic review and reconstructed individual patient data meta-analysis
Abstract Background Early postoperative atrial fibrillation (early-POAF) is the most common complication after cardiac surgery. Although prior studies have demonstrated an association between early-POAF and late outcomes, it is questionable whether these long-term adverse events result from early-PO...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-06-01
|
| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13019-025-03504-9 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850207383840620544 |
|---|---|
| author | Michal J. Kawczynski Claudia A. J. van der Heijden Jos G. Maessen Ulrich Schotten Mariusz Kowalewski Piotr Suwalski Elham Bidar Bart Maesen |
| author_facet | Michal J. Kawczynski Claudia A. J. van der Heijden Jos G. Maessen Ulrich Schotten Mariusz Kowalewski Piotr Suwalski Elham Bidar Bart Maesen |
| author_sort | Michal J. Kawczynski |
| collection | DOAJ |
| description | Abstract Background Early postoperative atrial fibrillation (early-POAF) is the most common complication after cardiac surgery. Although prior studies have demonstrated an association between early-POAF and late outcomes, it is questionable whether these long-term adverse events result from early-POAF or from comorbidities that underlie the development of early-POAF. Therefore, the aim of this study was to investigate the association of early-POAF with late mortality and stroke after adjustment for age and cardiovascular comorbidities. Methods A systematic search was conducted to identify studies reporting on late mortality after cardiac surgery in patients with and without early-POAF. Articles presenting Kaplan–Meier were included for a pooled analysis of late mortality (primary outcome) and stroke (secondary outcome). Individual time-to-event data were reconstructed from the Kaplan–Meier curves and incorporated into a multivariable mixed-effects Cox model. Results In total, 33 studies were included in the analysis for late mortality (131 031 patients) and 10 studies in the analysis for late stroke (42 042 patients). Overall, 36 991 patients had early-POAF with a pooled incidence of 31.5% (95% CI: 27.7 to 35.6%). Unadjusted analysis showed that early-POAF was significantly associated with late mortality (Hazard Ratio [HR] = 1.62, 95%CI: 1.58–1.67, P < 0.001) and late stroke (HR = 1.72, 95%CI: 1.61–1.85, P < 0.001). Early-POAF was significantly associated with late mortality (adjusted HR = 1.19, 95% CI: 1.07–1.33, P = 0.002), but not with late stroke (adjusted HR = 1.14, 95% CI: 0.96–1.35, P = 0.122) after adjustment for age, comorbidities, surgery type, and the random effects term. Conclusion Early-POAF after cardiac surgery is significantly associated with late mortality, but not with late stroke, after adjustments for age, sex, cardiovascular comorbidities, and type of surgery. |
| format | Article |
| id | doaj-art-81bd6fce172448e18742b1d15bbbb076 |
| institution | OA Journals |
| issn | 1749-8090 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj-art-81bd6fce172448e18742b1d15bbbb0762025-08-20T02:10:32ZengBMCJournal of Cardiothoracic Surgery1749-80902025-06-0120111310.1186/s13019-025-03504-9Early postoperative atrial fibrillation is associated with late mortality after cardiac surgery: a systematic review and reconstructed individual patient data meta-analysisMichal J. Kawczynski0Claudia A. J. van der Heijden1Jos G. Maessen2Ulrich Schotten3Mariusz Kowalewski4Piotr Suwalski5Elham Bidar6Bart Maesen7Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical CentreDepartment of Cardiology, Heart and Vascular Centre, Maastricht University Medical CentreDepartment of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical CentreDepartment of Physiology, Maastricht UniversityCardiovascular Research Institute Maastricht (CARIM)Clinical Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical EducationDepartment of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical CentreDepartment of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical CentreAbstract Background Early postoperative atrial fibrillation (early-POAF) is the most common complication after cardiac surgery. Although prior studies have demonstrated an association between early-POAF and late outcomes, it is questionable whether these long-term adverse events result from early-POAF or from comorbidities that underlie the development of early-POAF. Therefore, the aim of this study was to investigate the association of early-POAF with late mortality and stroke after adjustment for age and cardiovascular comorbidities. Methods A systematic search was conducted to identify studies reporting on late mortality after cardiac surgery in patients with and without early-POAF. Articles presenting Kaplan–Meier were included for a pooled analysis of late mortality (primary outcome) and stroke (secondary outcome). Individual time-to-event data were reconstructed from the Kaplan–Meier curves and incorporated into a multivariable mixed-effects Cox model. Results In total, 33 studies were included in the analysis for late mortality (131 031 patients) and 10 studies in the analysis for late stroke (42 042 patients). Overall, 36 991 patients had early-POAF with a pooled incidence of 31.5% (95% CI: 27.7 to 35.6%). Unadjusted analysis showed that early-POAF was significantly associated with late mortality (Hazard Ratio [HR] = 1.62, 95%CI: 1.58–1.67, P < 0.001) and late stroke (HR = 1.72, 95%CI: 1.61–1.85, P < 0.001). Early-POAF was significantly associated with late mortality (adjusted HR = 1.19, 95% CI: 1.07–1.33, P = 0.002), but not with late stroke (adjusted HR = 1.14, 95% CI: 0.96–1.35, P = 0.122) after adjustment for age, comorbidities, surgery type, and the random effects term. Conclusion Early-POAF after cardiac surgery is significantly associated with late mortality, but not with late stroke, after adjustments for age, sex, cardiovascular comorbidities, and type of surgery.https://doi.org/10.1186/s13019-025-03504-9Postoperative atrial fibrillationCardiac surgeryMeta-analysisLong-term outcomes |
| spellingShingle | Michal J. Kawczynski Claudia A. J. van der Heijden Jos G. Maessen Ulrich Schotten Mariusz Kowalewski Piotr Suwalski Elham Bidar Bart Maesen Early postoperative atrial fibrillation is associated with late mortality after cardiac surgery: a systematic review and reconstructed individual patient data meta-analysis Journal of Cardiothoracic Surgery Postoperative atrial fibrillation Cardiac surgery Meta-analysis Long-term outcomes |
| title | Early postoperative atrial fibrillation is associated with late mortality after cardiac surgery: a systematic review and reconstructed individual patient data meta-analysis |
| title_full | Early postoperative atrial fibrillation is associated with late mortality after cardiac surgery: a systematic review and reconstructed individual patient data meta-analysis |
| title_fullStr | Early postoperative atrial fibrillation is associated with late mortality after cardiac surgery: a systematic review and reconstructed individual patient data meta-analysis |
| title_full_unstemmed | Early postoperative atrial fibrillation is associated with late mortality after cardiac surgery: a systematic review and reconstructed individual patient data meta-analysis |
| title_short | Early postoperative atrial fibrillation is associated with late mortality after cardiac surgery: a systematic review and reconstructed individual patient data meta-analysis |
| title_sort | early postoperative atrial fibrillation is associated with late mortality after cardiac surgery a systematic review and reconstructed individual patient data meta analysis |
| topic | Postoperative atrial fibrillation Cardiac surgery Meta-analysis Long-term outcomes |
| url | https://doi.org/10.1186/s13019-025-03504-9 |
| work_keys_str_mv | AT michaljkawczynski earlypostoperativeatrialfibrillationisassociatedwithlatemortalityaftercardiacsurgeryasystematicreviewandreconstructedindividualpatientdatametaanalysis AT claudiaajvanderheijden earlypostoperativeatrialfibrillationisassociatedwithlatemortalityaftercardiacsurgeryasystematicreviewandreconstructedindividualpatientdatametaanalysis AT josgmaessen earlypostoperativeatrialfibrillationisassociatedwithlatemortalityaftercardiacsurgeryasystematicreviewandreconstructedindividualpatientdatametaanalysis AT ulrichschotten earlypostoperativeatrialfibrillationisassociatedwithlatemortalityaftercardiacsurgeryasystematicreviewandreconstructedindividualpatientdatametaanalysis AT mariuszkowalewski earlypostoperativeatrialfibrillationisassociatedwithlatemortalityaftercardiacsurgeryasystematicreviewandreconstructedindividualpatientdatametaanalysis AT piotrsuwalski earlypostoperativeatrialfibrillationisassociatedwithlatemortalityaftercardiacsurgeryasystematicreviewandreconstructedindividualpatientdatametaanalysis AT elhambidar earlypostoperativeatrialfibrillationisassociatedwithlatemortalityaftercardiacsurgeryasystematicreviewandreconstructedindividualpatientdatametaanalysis AT bartmaesen earlypostoperativeatrialfibrillationisassociatedwithlatemortalityaftercardiacsurgeryasystematicreviewandreconstructedindividualpatientdatametaanalysis |