心脏手术后早期心房颤动与晚期死亡率相关：一项系统综述和重建的个体患者数据荟萃分析。

IF 1.5 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiothoracic Surgery Pub Date : 2025-06-18 DOI:10.1186/s13019-025-03504-9

Michal J Kawczynski, Claudia A J van der Heijden, Jos G Maessen, Ulrich Schotten, Mariusz Kowalewski, Piotr Suwalski, Elham Bidar, Bart Maesen

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引用次数: 0

摘要

背景：术后早期心房颤动（Early - poaf）是心脏手术后最常见的并发症。尽管先前的研究表明早期poaf与晚期预后之间存在关联，但这些长期不良事件是由早期poaf引起的，还是由早期poaf发展背后的合并症引起的，这一点尚存疑问。因此，本研究的目的是在调整年龄和心血管合并症后，探讨早期poaf与晚期死亡率和卒中的关系。方法：对有或无早期poaf患者心脏手术后晚期死亡率的研究进行系统检索。提出Kaplan-Meier的文章被纳入晚期死亡率（主要结局）和卒中（次要结局）的汇总分析。从Kaplan-Meier曲线重构个体事件时间数据，并将其纳入多变量混合效应Cox模型。结果：共有33项研究纳入晚期死亡率分析（131031例），10项研究纳入晚期卒中分析（42042例）。总的来说，36991例患者有早期poaf，合并发病率为31.5% （95% CI: 27.7 - 35.6%）。未经校正的分析显示，早期poaf与晚期死亡率显著相关（危险比[HR] = 1.62, 95%CI: 1.58-1.67， P）。结论：心脏手术后早期poaf与晚期死亡率显著相关，但与晚期卒中无关，校正了年龄、性别、心血管合共病和手术类型。

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Early postoperative atrial fibrillation is associated with late mortality after cardiac surgery: a systematic review and reconstructed individual patient data meta-analysis.

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.

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来源期刊

Journal of Cardiothoracic Surgery 医学-心血管系统

CiteScore

2.50

自引率

6.20%

发文量

286

审稿时长

4-8 weeks

期刊介绍： Journal of Cardiothoracic Surgery is an open access journal that encompasses all aspects of research in the field of Cardiology, and Cardiothoracic and Vascular Surgery. The journal publishes original scientific research documenting clinical and experimental advances in cardiac, vascular and thoracic surgery, and related fields. Topics of interest include surgical techniques, survival rates, surgical complications and their outcomes; along with basic sciences, pediatric conditions, transplantations and clinical trials. Journal of Cardiothoracic Surgery is of interest to cardiothoracic and vascular surgeons, cardiothoracic anaesthesiologists, cardiologists, chest physicians, and allied health professionals.