Age and neo-adjuvant chemotherapy increase the risk of atrial fibrillation following oesophagectomy
OBJECTIVES Atrial tachyarrhythmias occur in up to 25% of patients after major thoracic surgery. We examined risk factors for new-onset atrial fibrillation (AF) following oesophagectomy in an attempt to guide prophylactic use of anti-arrhythmic strategies. METHODS Data were extracted from a database...
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| Veröffentlicht in: | European journal of cardio-thoracic surgery 2012-09, Vol.42 (3), p.438-443 |
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| container_title | European journal of cardio-thoracic surgery |
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| creator | Rao, Vinay P. Addae-Boateng, Emmanuel Barua, Anupama Martin-Ucar, Antonio E. Duffy, John P. |
| description | OBJECTIVES
Atrial tachyarrhythmias occur in up to 25% of patients after major thoracic surgery. We examined risk factors for new-onset atrial fibrillation (AF) following oesophagectomy in an attempt to guide prophylactic use of anti-arrhythmic strategies.
METHODS
Data were extracted from a database of patients who underwent oesophagectomy between 1991 and 2009. Patients with pre-operative arrhythmias were excluded leaving 997 patients for further analysis. Univariate and multivariate logistic regression analyses were performed to identify factors predicting AF, and receiver operating characteristic curves were generated from a model using these predictors. Statistical significance was reflected in a P-value of |
| doi_str_mv | 10.1093/ejcts/ezs085 |
| format | Article |
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Atrial tachyarrhythmias occur in up to 25% of patients after major thoracic surgery. We examined risk factors for new-onset atrial fibrillation (AF) following oesophagectomy in an attempt to guide prophylactic use of anti-arrhythmic strategies.
METHODS
Data were extracted from a database of patients who underwent oesophagectomy between 1991 and 2009. Patients with pre-operative arrhythmias were excluded leaving 997 patients for further analysis. Univariate and multivariate logistic regression analyses were performed to identify factors predicting AF, and receiver operating characteristic curves were generated from a model using these predictors. Statistical significance was reflected in a P-value of <0.05.
RESULTS
Patients who developed AF (n = 209; 20.96%) were older (median age 70.54 years vs. 66.9 years; P < 0.01) and included 141 males (67.4%) (P = 0.11). Patients with AF were noted to have a higher in-hospital mortality rate (n = 17; 8.1% vs. n = 34; 4.8%) (P = 0.04) and a longer stay in hospital (14 days vs. 12 days; P < 0.01). Multivariate analysis identified advanced age and neo-adjuvant chemotherapy to be independent predictors of the risk of developing AF. Assessment of discriminative ability of a predictive model revealed a c-statistic of just 0.62.
CONCLUSIONS
Despite the identification of age and neo-adjuvant chemotherapy as predictors of AF, the moderate discriminative ability of predictive modelling does not support the use of prophylactic anti-arrhythmic drugs. However, the high incidence of AF after major thoracic surgery makes it necessary to understand its underlying mechanisms better before prophylactic strategies are considered.</description><identifier>ISSN: 1010-7940</identifier><identifier>EISSN: 1873-734X</identifier><identifier>DOI: 10.1093/ejcts/ezs085</identifier><identifier>PMID: 22390986</identifier><identifier>CODEN: EJCSE7</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Age Factors ; Aged ; Analysis of Variance ; Antineoplastic Agents - adverse effects ; Antineoplastic Agents - therapeutic use ; Atrial Fibrillation - etiology ; Atrial Fibrillation - mortality ; Atrial Fibrillation - physiopathology ; Biological and medical sciences ; Cardiac dysrhythmias ; Cardiology. Vascular system ; Databases, Factual ; Esophageal Neoplasms - drug therapy ; Esophageal Neoplasms - pathology ; Esophageal Neoplasms - surgery ; Esophagectomy - adverse effects ; Esophagectomy - methods ; Esophagus ; Female ; Follow-Up Studies ; Gastroenterology. Liver. Pancreas. Abdomen ; Heart ; Hospital Mortality - trends ; Humans ; Logistic Models ; Male ; Medical sciences ; Middle Aged ; Multivariate Analysis ; Neoadjuvant Therapy - adverse effects ; Neoadjuvant Therapy - methods ; Neoplasm Staging ; Pneumology ; Postoperative Complications - epidemiology ; Postoperative Complications - physiopathology ; Predictive Value of Tests ; Preoperative Care - methods ; Retrospective Studies ; Risk Assessment ; ROC Curve ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart ; Survival Rate ; Treatment Outcome ; Tumors ; United Kingdom</subject><ispartof>European journal of cardio-thoracic surgery, 2012-09, Vol.42 (3), p.438-443</ispartof><rights>The Author 2012. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. 2012</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c457t-a5adeb7bf9d68b3f646c0decf3ebb81ff433f3f3e1681095f846b0db362f9a7c3</citedby><cites>FETCH-LOGICAL-c457t-a5adeb7bf9d68b3f646c0decf3ebb81ff433f3f3e1681095f846b0db362f9a7c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1578,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26264903$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22390986$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rao, Vinay P.</creatorcontrib><creatorcontrib>Addae-Boateng, Emmanuel</creatorcontrib><creatorcontrib>Barua, Anupama</creatorcontrib><creatorcontrib>Martin-Ucar, Antonio E.</creatorcontrib><creatorcontrib>Duffy, John P.</creatorcontrib><title>Age and neo-adjuvant chemotherapy increase the risk of atrial fibrillation following oesophagectomy</title><title>European journal of cardio-thoracic surgery</title><addtitle>Eur J Cardiothorac Surg</addtitle><description>OBJECTIVES
Atrial tachyarrhythmias occur in up to 25% of patients after major thoracic surgery. We examined risk factors for new-onset atrial fibrillation (AF) following oesophagectomy in an attempt to guide prophylactic use of anti-arrhythmic strategies.
METHODS
Data were extracted from a database of patients who underwent oesophagectomy between 1991 and 2009. Patients with pre-operative arrhythmias were excluded leaving 997 patients for further analysis. Univariate and multivariate logistic regression analyses were performed to identify factors predicting AF, and receiver operating characteristic curves were generated from a model using these predictors. Statistical significance was reflected in a P-value of <0.05.
RESULTS
Patients who developed AF (n = 209; 20.96%) were older (median age 70.54 years vs. 66.9 years; P < 0.01) and included 141 males (67.4%) (P = 0.11). Patients with AF were noted to have a higher in-hospital mortality rate (n = 17; 8.1% vs. n = 34; 4.8%) (P = 0.04) and a longer stay in hospital (14 days vs. 12 days; P < 0.01). Multivariate analysis identified advanced age and neo-adjuvant chemotherapy to be independent predictors of the risk of developing AF. Assessment of discriminative ability of a predictive model revealed a c-statistic of just 0.62.
CONCLUSIONS
Despite the identification of age and neo-adjuvant chemotherapy as predictors of AF, the moderate discriminative ability of predictive modelling does not support the use of prophylactic anti-arrhythmic drugs. However, the high incidence of AF after major thoracic surgery makes it necessary to understand its underlying mechanisms better before prophylactic strategies are considered.</description><subject>Age Factors</subject><subject>Aged</subject><subject>Analysis of Variance</subject><subject>Antineoplastic Agents - adverse effects</subject><subject>Antineoplastic Agents - therapeutic use</subject><subject>Atrial Fibrillation - etiology</subject><subject>Atrial Fibrillation - mortality</subject><subject>Atrial Fibrillation - physiopathology</subject><subject>Biological and medical sciences</subject><subject>Cardiac dysrhythmias</subject><subject>Cardiology. Vascular system</subject><subject>Databases, Factual</subject><subject>Esophageal Neoplasms - drug therapy</subject><subject>Esophageal Neoplasms - pathology</subject><subject>Esophageal Neoplasms - surgery</subject><subject>Esophagectomy - adverse effects</subject><subject>Esophagectomy - methods</subject><subject>Esophagus</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Heart</subject><subject>Hospital Mortality - trends</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Neoadjuvant Therapy - adverse effects</subject><subject>Neoadjuvant Therapy - methods</subject><subject>Neoplasm Staging</subject><subject>Pneumology</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - physiopathology</subject><subject>Predictive Value of Tests</subject><subject>Preoperative Care - methods</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>ROC Curve</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the heart</subject><subject>Survival Rate</subject><subject>Treatment Outcome</subject><subject>Tumors</subject><subject>United Kingdom</subject><issn>1010-7940</issn><issn>1873-734X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90MtKxDAUBuAgipfRnWvJRnRhNW3atF0O4g0ENwruykl6MpOxbWrSKuPTG51Rd5JFQvg4l5-Qw5idx6zkF7hQg7_AD8-KbIPsxkXOo5ynz5vhzWIW5WXKdsie9wvGmOBJvk12koSXrCzELlHTGVLoatqhjaBejG_QDVTNsbXDHB30S2o65RA80vBBnfEv1GoKgzPQUG2kM00Dg7Ed1bZp7LvpZtSit_0cZqgG2y73yZaGxuPB-p6Qp-urx8vb6P7h5u5yeh-pNMuHCDKoUeZSl7UoJNciFYrVqDRHKYtY65RzHQ7GogibZ7pIhWS15CLRJeSKT8jpqm7v7OuIfqha4xWG8cJyo69ixnmaiSJPAj1bUeWs9w511TvTglsGVH3FWn3HWq1iDfxoXXmULda_-CfHAI7XALyCRjvolPF_TiQiLUP7CTlZOTv2_7f8BGH6klo</recordid><startdate>20120901</startdate><enddate>20120901</enddate><creator>Rao, Vinay P.</creator><creator>Addae-Boateng, Emmanuel</creator><creator>Barua, Anupama</creator><creator>Martin-Ucar, Antonio E.</creator><creator>Duffy, John P.</creator><general>Oxford University Press</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20120901</creationdate><title>Age and neo-adjuvant chemotherapy increase the risk of atrial fibrillation following oesophagectomy</title><author>Rao, Vinay P. ; Addae-Boateng, Emmanuel ; Barua, Anupama ; Martin-Ucar, Antonio E. ; Duffy, John P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c457t-a5adeb7bf9d68b3f646c0decf3ebb81ff433f3f3e1681095f846b0db362f9a7c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Age Factors</topic><topic>Aged</topic><topic>Analysis of Variance</topic><topic>Antineoplastic Agents - adverse effects</topic><topic>Antineoplastic Agents - therapeutic use</topic><topic>Atrial Fibrillation - etiology</topic><topic>Atrial Fibrillation - mortality</topic><topic>Atrial Fibrillation - physiopathology</topic><topic>Biological and medical sciences</topic><topic>Cardiac dysrhythmias</topic><topic>Cardiology. Vascular system</topic><topic>Databases, Factual</topic><topic>Esophageal Neoplasms - drug therapy</topic><topic>Esophageal Neoplasms - pathology</topic><topic>Esophageal Neoplasms - surgery</topic><topic>Esophagectomy - adverse effects</topic><topic>Esophagectomy - methods</topic><topic>Esophagus</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Heart</topic><topic>Hospital Mortality - trends</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Neoadjuvant Therapy - adverse effects</topic><topic>Neoadjuvant Therapy - methods</topic><topic>Neoplasm Staging</topic><topic>Pneumology</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - physiopathology</topic><topic>Predictive Value of Tests</topic><topic>Preoperative Care - methods</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>ROC Curve</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the heart</topic><topic>Survival Rate</topic><topic>Treatment Outcome</topic><topic>Tumors</topic><topic>United Kingdom</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rao, Vinay P.</creatorcontrib><creatorcontrib>Addae-Boateng, Emmanuel</creatorcontrib><creatorcontrib>Barua, Anupama</creatorcontrib><creatorcontrib>Martin-Ucar, Antonio E.</creatorcontrib><creatorcontrib>Duffy, John P.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of cardio-thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rao, Vinay P.</au><au>Addae-Boateng, Emmanuel</au><au>Barua, Anupama</au><au>Martin-Ucar, Antonio E.</au><au>Duffy, John P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Age and neo-adjuvant chemotherapy increase the risk of atrial fibrillation following oesophagectomy</atitle><jtitle>European journal of cardio-thoracic surgery</jtitle><addtitle>Eur J Cardiothorac Surg</addtitle><date>2012-09-01</date><risdate>2012</risdate><volume>42</volume><issue>3</issue><spage>438</spage><epage>443</epage><pages>438-443</pages><issn>1010-7940</issn><eissn>1873-734X</eissn><coden>EJCSE7</coden><abstract>OBJECTIVES
Atrial tachyarrhythmias occur in up to 25% of patients after major thoracic surgery. We examined risk factors for new-onset atrial fibrillation (AF) following oesophagectomy in an attempt to guide prophylactic use of anti-arrhythmic strategies.
METHODS
Data were extracted from a database of patients who underwent oesophagectomy between 1991 and 2009. Patients with pre-operative arrhythmias were excluded leaving 997 patients for further analysis. Univariate and multivariate logistic regression analyses were performed to identify factors predicting AF, and receiver operating characteristic curves were generated from a model using these predictors. Statistical significance was reflected in a P-value of <0.05.
RESULTS
Patients who developed AF (n = 209; 20.96%) were older (median age 70.54 years vs. 66.9 years; P < 0.01) and included 141 males (67.4%) (P = 0.11). Patients with AF were noted to have a higher in-hospital mortality rate (n = 17; 8.1% vs. n = 34; 4.8%) (P = 0.04) and a longer stay in hospital (14 days vs. 12 days; P < 0.01). Multivariate analysis identified advanced age and neo-adjuvant chemotherapy to be independent predictors of the risk of developing AF. Assessment of discriminative ability of a predictive model revealed a c-statistic of just 0.62.
CONCLUSIONS
Despite the identification of age and neo-adjuvant chemotherapy as predictors of AF, the moderate discriminative ability of predictive modelling does not support the use of prophylactic anti-arrhythmic drugs. However, the high incidence of AF after major thoracic surgery makes it necessary to understand its underlying mechanisms better before prophylactic strategies are considered.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>22390986</pmid><doi>10.1093/ejcts/ezs085</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Age Factors Aged Analysis of Variance Antineoplastic Agents - adverse effects Antineoplastic Agents - therapeutic use Atrial Fibrillation - etiology Atrial Fibrillation - mortality Atrial Fibrillation - physiopathology Biological and medical sciences Cardiac dysrhythmias Cardiology. Vascular system Databases, Factual Esophageal Neoplasms - drug therapy Esophageal Neoplasms - pathology Esophageal Neoplasms - surgery Esophagectomy - adverse effects Esophagectomy - methods Esophagus Female Follow-Up Studies Gastroenterology. Liver. Pancreas. Abdomen Heart Hospital Mortality - trends Humans Logistic Models Male Medical sciences Middle Aged Multivariate Analysis Neoadjuvant Therapy - adverse effects Neoadjuvant Therapy - methods Neoplasm Staging Pneumology Postoperative Complications - epidemiology Postoperative Complications - physiopathology Predictive Value of Tests Preoperative Care - methods Retrospective Studies Risk Assessment ROC Curve Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Survival Rate Treatment Outcome Tumors United Kingdom |
| title | Age and neo-adjuvant chemotherapy increase the risk of atrial fibrillation following oesophagectomy |
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