A time-related parametric risk factor analysis for postoperative atrial fibrillation after heart surgery
Objectives Multiple mechanisms may be involved in postoperative atrial fibrillation. Therefore, our objective was to determine the risk factors for postoperative atrial fibrillation as a function of time after coronary artery bypass grafting or valve surgeries to determine which risk factors might p...
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| Veröffentlicht in: | The Journal of thoracic and cardiovascular surgery 2015-03, Vol.149 (3), p.886-892 |
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| container_title | The Journal of thoracic and cardiovascular surgery |
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| creator | Melby, Spencer J., MD George, James F., PhD Picone, Desiree J., MD Wallace, Jerald Payden, MD Davies, James E., MD George, David J Kirklin, James K., MD |
| description | Objectives Multiple mechanisms may be involved in postoperative atrial fibrillation. Therefore, our objective was to determine the risk factors for postoperative atrial fibrillation as a function of time after coronary artery bypass grafting or valve surgeries to determine which risk factors might predominate at different times. Methods Parametric hazard functions were determined for 1583 patients and then in subgroups (coronary artery bypass grafting alone, mitral valve procedure, and aortic valve replacement +/− coronary artery bypass grafting). Multivariable risk factor analyses were performed, and the risk for postoperative atrial fibrillation was estimated. Results The risk for postoperative atrial fibrillation for all patients was highest immediately postoperatively and at 48 hours. The initial peak risk declined to approximately zero within 18 hours postoperatively. A second peak occurred at 48 hours, followed by a slow decline over the following 4 to 7 days. The time intervals encompassing these peaks were termed phase I and phase II. Predominant risk factors in phase I were older age (relative risk [RR], 1.6; P = .006), longer crossclamp time (RR, 1.3; P = .001), and mitral valve procedure (RR, 2.5; P = .0001). In phase II, these were older age (RR, 3.0; P |
| doi_str_mv | 10.1016/j.jtcvs.2014.11.032 |
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Therefore, our objective was to determine the risk factors for postoperative atrial fibrillation as a function of time after coronary artery bypass grafting or valve surgeries to determine which risk factors might predominate at different times. Methods Parametric hazard functions were determined for 1583 patients and then in subgroups (coronary artery bypass grafting alone, mitral valve procedure, and aortic valve replacement +/− coronary artery bypass grafting). Multivariable risk factor analyses were performed, and the risk for postoperative atrial fibrillation was estimated. Results The risk for postoperative atrial fibrillation for all patients was highest immediately postoperatively and at 48 hours. The initial peak risk declined to approximately zero within 18 hours postoperatively. A second peak occurred at 48 hours, followed by a slow decline over the following 4 to 7 days. The time intervals encompassing these peaks were termed phase I and phase II. Predominant risk factors in phase I were older age (relative risk [RR], 1.6; P = .006), longer crossclamp time (RR, 1.3; P = .001), and mitral valve procedure (RR, 2.5; P = .0001). In phase II, these were older age (RR, 3.0; P < .0001), greater weight (RR, 1.6; P < .0001), and Caucasian race (RR, 2.5; P = .006). For patients receiving a mitral valve procedure, the risk for postoperative atrial fibrillation in phase II was higher and remained elevated for as long as 9 days postoperatively in comparison with isolated coronary artery bypass grafting, for which the risk returned to near baseline by postoperative day 6. Conclusions Phase I and phase II periods are associated with distinct risk factors; therefore, it is likely that the mechanisms of postoperative atrial fibrillation change over time.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2014.11.032</identifier><identifier>PMID: 25534301</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Age Factors ; Aged ; Alabama - epidemiology ; Aortic Valve - surgery ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - ethnology ; Atrial Fibrillation - etiology ; Cardiothoracic Surgery ; Coronary Artery Bypass - adverse effects ; Disease-Free Survival ; European Continental Ancestry Group ; Female ; Heart Valve Prosthesis Implantation - adverse effects ; Humans ; Kaplan-Meier Estimate ; Linear Models ; Male ; Middle Aged ; Mitral Valve - surgery ; Multivariate Analysis ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2015-03, Vol.149 (3), p.886-892</ispartof><rights>2015</rights><rights>Copyright © 2015. Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c595t-c7f0c4ef7c95f1fb0bf1e83ee31106040cfe27418a9d3c5f4d2c115aca33523b3</citedby><cites>FETCH-LOGICAL-c595t-c7f0c4ef7c95f1fb0bf1e83ee31106040cfe27418a9d3c5f4d2c115aca33523b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jtcvs.2014.11.032$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,45974</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25534301$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Melby, Spencer J., MD</creatorcontrib><creatorcontrib>George, James F., PhD</creatorcontrib><creatorcontrib>Picone, Desiree J., MD</creatorcontrib><creatorcontrib>Wallace, Jerald Payden, MD</creatorcontrib><creatorcontrib>Davies, James E., MD</creatorcontrib><creatorcontrib>George, David J</creatorcontrib><creatorcontrib>Kirklin, James K., MD</creatorcontrib><title>A time-related parametric risk factor analysis for postoperative atrial fibrillation after heart surgery</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>Objectives Multiple mechanisms may be involved in postoperative atrial fibrillation. Therefore, our objective was to determine the risk factors for postoperative atrial fibrillation as a function of time after coronary artery bypass grafting or valve surgeries to determine which risk factors might predominate at different times. Methods Parametric hazard functions were determined for 1583 patients and then in subgroups (coronary artery bypass grafting alone, mitral valve procedure, and aortic valve replacement +/− coronary artery bypass grafting). Multivariable risk factor analyses were performed, and the risk for postoperative atrial fibrillation was estimated. Results The risk for postoperative atrial fibrillation for all patients was highest immediately postoperatively and at 48 hours. The initial peak risk declined to approximately zero within 18 hours postoperatively. A second peak occurred at 48 hours, followed by a slow decline over the following 4 to 7 days. The time intervals encompassing these peaks were termed phase I and phase II. Predominant risk factors in phase I were older age (relative risk [RR], 1.6; P = .006), longer crossclamp time (RR, 1.3; P = .001), and mitral valve procedure (RR, 2.5; P = .0001). In phase II, these were older age (RR, 3.0; P < .0001), greater weight (RR, 1.6; P < .0001), and Caucasian race (RR, 2.5; P = .006). For patients receiving a mitral valve procedure, the risk for postoperative atrial fibrillation in phase II was higher and remained elevated for as long as 9 days postoperatively in comparison with isolated coronary artery bypass grafting, for which the risk returned to near baseline by postoperative day 6. Conclusions Phase I and phase II periods are associated with distinct risk factors; therefore, it is likely that the mechanisms of postoperative atrial fibrillation change over time.</description><subject>Age Factors</subject><subject>Aged</subject><subject>Alabama - epidemiology</subject><subject>Aortic Valve - surgery</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial Fibrillation - ethnology</subject><subject>Atrial Fibrillation - etiology</subject><subject>Cardiothoracic Surgery</subject><subject>Coronary Artery Bypass - adverse effects</subject><subject>Disease-Free Survival</subject><subject>European Continental Ancestry Group</subject><subject>Female</subject><subject>Heart Valve Prosthesis Implantation - adverse effects</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Linear Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mitral Valve - surgery</subject><subject>Multivariate Analysis</subject><subject>Proportional Hazards Models</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUuLFTEQhYMoznX0FwiSpZtuq5JO9-2FwjCMDxhwoYK7kE5XnPT0yyR94f57c72jCzeuioJz6vEdxl4ilAhYvxnKIdlDLAVgVSKWIMUjtkNom6Leq--P2Q5AiEIJIS_YsxgHAGgA26fsQiglKwm4Y3dXPPmJikCjSdTz1QQzUQre8uDjPXfGpiVwM5vxGH3kLjfrEtOyUjDJH4ibLDYjd74LfsxD_DJz4xIFfkcmJB638IPC8Tl74swY6cVDvWTf3t98vf5Y3H7-8On66rawqlWpsI0DW5FrbKscug46h7SXRBIRaqjAOhJNhXvT9tIqV_XCIipjjZRKyE5estfnuWtYfm4Uk558tJQvm2nZosa6bislJTZZKs9SG5YYAzm9Bj-ZcNQI-oRYD_o3Yn1CrBF1Rpxdrx4WbN1E_V_PH6ZZ8PYsoPzmwVPQ0XqaLfU-kE26X_x_Frz7x29HP3trxns6UhyWLeQ08ic6Cg36yynlU8hYAe5RoPwFANClKA</recordid><startdate>20150301</startdate><enddate>20150301</enddate><creator>Melby, Spencer J., MD</creator><creator>George, James F., PhD</creator><creator>Picone, Desiree J., MD</creator><creator>Wallace, Jerald Payden, MD</creator><creator>Davies, James E., MD</creator><creator>George, David J</creator><creator>Kirklin, James K., MD</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</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>20150301</creationdate><title>A time-related parametric risk factor analysis for postoperative atrial fibrillation after heart surgery</title><author>Melby, Spencer J., MD ; George, James F., PhD ; Picone, Desiree J., MD ; Wallace, Jerald Payden, MD ; Davies, James E., MD ; George, David J ; Kirklin, James K., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c595t-c7f0c4ef7c95f1fb0bf1e83ee31106040cfe27418a9d3c5f4d2c115aca33523b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Age Factors</topic><topic>Aged</topic><topic>Alabama - epidemiology</topic><topic>Aortic Valve - surgery</topic><topic>Atrial Fibrillation - diagnosis</topic><topic>Atrial Fibrillation - ethnology</topic><topic>Atrial Fibrillation - etiology</topic><topic>Cardiothoracic Surgery</topic><topic>Coronary Artery Bypass - adverse effects</topic><topic>Disease-Free Survival</topic><topic>European Continental Ancestry Group</topic><topic>Female</topic><topic>Heart Valve Prosthesis Implantation - adverse effects</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Linear Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mitral Valve - surgery</topic><topic>Multivariate Analysis</topic><topic>Proportional Hazards Models</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Melby, Spencer J., MD</creatorcontrib><creatorcontrib>George, James F., PhD</creatorcontrib><creatorcontrib>Picone, Desiree J., MD</creatorcontrib><creatorcontrib>Wallace, Jerald Payden, MD</creatorcontrib><creatorcontrib>Davies, James E., MD</creatorcontrib><creatorcontrib>George, David J</creatorcontrib><creatorcontrib>Kirklin, James K., MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</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>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Melby, Spencer J., MD</au><au>George, James F., PhD</au><au>Picone, Desiree J., MD</au><au>Wallace, Jerald Payden, MD</au><au>Davies, James E., MD</au><au>George, David J</au><au>Kirklin, James K., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A time-related parametric risk factor analysis for postoperative atrial fibrillation after heart surgery</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2015-03-01</date><risdate>2015</risdate><volume>149</volume><issue>3</issue><spage>886</spage><epage>892</epage><pages>886-892</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><abstract>Objectives Multiple mechanisms may be involved in postoperative atrial fibrillation. Therefore, our objective was to determine the risk factors for postoperative atrial fibrillation as a function of time after coronary artery bypass grafting or valve surgeries to determine which risk factors might predominate at different times. Methods Parametric hazard functions were determined for 1583 patients and then in subgroups (coronary artery bypass grafting alone, mitral valve procedure, and aortic valve replacement +/− coronary artery bypass grafting). Multivariable risk factor analyses were performed, and the risk for postoperative atrial fibrillation was estimated. Results The risk for postoperative atrial fibrillation for all patients was highest immediately postoperatively and at 48 hours. The initial peak risk declined to approximately zero within 18 hours postoperatively. A second peak occurred at 48 hours, followed by a slow decline over the following 4 to 7 days. The time intervals encompassing these peaks were termed phase I and phase II. Predominant risk factors in phase I were older age (relative risk [RR], 1.6; P = .006), longer crossclamp time (RR, 1.3; P = .001), and mitral valve procedure (RR, 2.5; P = .0001). In phase II, these were older age (RR, 3.0; P < .0001), greater weight (RR, 1.6; P < .0001), and Caucasian race (RR, 2.5; P = .006). For patients receiving a mitral valve procedure, the risk for postoperative atrial fibrillation in phase II was higher and remained elevated for as long as 9 days postoperatively in comparison with isolated coronary artery bypass grafting, for which the risk returned to near baseline by postoperative day 6. Conclusions Phase I and phase II periods are associated with distinct risk factors; therefore, it is likely that the mechanisms of postoperative atrial fibrillation change over time.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25534301</pmid><doi>10.1016/j.jtcvs.2014.11.032</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Age Factors Aged Alabama - epidemiology Aortic Valve - surgery Atrial Fibrillation - diagnosis Atrial Fibrillation - ethnology Atrial Fibrillation - etiology Cardiothoracic Surgery Coronary Artery Bypass - adverse effects Disease-Free Survival European Continental Ancestry Group Female Heart Valve Prosthesis Implantation - adverse effects Humans Kaplan-Meier Estimate Linear Models Male Middle Aged Mitral Valve - surgery Multivariate Analysis Proportional Hazards Models Retrospective Studies Risk Factors Time Factors Treatment Outcome |
| title | A time-related parametric risk factor analysis for postoperative atrial fibrillation after heart surgery |
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