Impact of postoperative atrial fibrillation (POAF) on outcomes after coronary artery bypass grafting: A meta-analysis of unique 247,270 patients from 50 studies

Background

Postoperative atrial fibrillation (POAF) can occur in up to 53.1 % of patients undergoing cardiac surgery. This serious condition has been associated with increased risk of morbidity and mortality during the initial weeks after the procedure. In this updated meta-analysis, we aim to study the impact of POAF on outcomes in patients undergoing CABG surgery.

Methods

We searched PubMed, Scopus, Cochrane Library, and WOS from inception till April 15, 2024. The pooled effect sizes were mean difference (MD) for continuous outcomes and odds ratio (OR) for dichotomous outcomes and a 95 % confidence interval (CI).

Results

A total of 247,270 patients from 50 studies were included. Mean age ranged between 56.5 and 76 years and mean follow-up time duration ranged from six months to 15 years. In-hospital, 30-days, and long-term mortality were significantly higher in patients with POAF compared to patients without POAF with (OR: 2.37; 95 % CI: 1.45–3.87; P = 0.0033), (OR: 2.33; 95 % CI: 1.74–3.13; P < 0.01), and (OR: 2.15; 95 % CI: 1.8–2.54; P < 0.01respectively. In terms of stroke, both short- and long-term strokes were significantly higher in patients with POAF with (OR: 2.54; 95 % CI: 2.05–3.15; P < 0.01) and (OR: 1.92; 95 % CI: 1.37–2.68; P < 0.0007), respectively. Although POAF has significant longer hospital and intensive care unit stay and higher risk for post-operative renal failure and myocardial infarction, there was no significant difference in revascularization and reintubation rates in patients with POAF with (OR: 1.11; 95 % CI: 0.48–2.54; P = 0.656) and (OR: 2.72; 95 % CI: 0.86–8.67; P = 0.0742), respectively. The need for intra-aortic balloon pump was higher in POAF group with (OR: 1.84; 95 % CI: 1.42–2.37; P < 0.01) as well as the risk of developing heart failure with OR: 1.8; 95 % CI: 1.43–2.26; P = 0.0012.

Conclusion

Our findings suggest that POAF group may be associated with higher short-term mortality, long-term mortality, and length of hospital and ICU stay in patients undergoing CABG. Furthermore, there was a higher association between POAF and some postoperative complications such as stroke, acute renal failure, acute heart failure, and pneumonia. However, POAF did not seem to significantly affect rates of acute MI and reintubation.