Abstract

Objectives

Atrial fibrillation is the most common arrhythmia occurring after cardiac surgery. Less attention has been focused on preoperative atrial fibrillation and anaemia as risk factors for mortality after cardiac surgery. The aim of this study was to determine preoperative risk factors for 30-d mortality after open-heart surgery. Design. The study population consisted of 2015 patients (73.4% men; mean age 68 years) undergoing coronary artery bypass grafting (CABG) (52.0%), aortic valve replacement (AVR) (18.6%), AVR and CABG (10.0%), mitral valve plasty or replacement (14.0%), and AVR and aortic root reconstruction (ARR) (5.5%) in Kuopio University Hospital from January 2013 to December 2016. Univariate and multivariate Cox proportional hazards models were used for statistical analyses. Kaplan–Meier survival curves were generated. Results. Total 30-d mortality was 1.8%. By Cox regression analysis, predictors of 30-d mortality (hazard ratio [HR] [95% confidence interval [CI]]) included female gender (1.95 [1.00–3.77]), preoperative atrial fibrillation, (2.38 [1.12–5.03]) reduced haemoglobin level (3.40 [1.47–7.90]), and pulmonary congestion (3.16 [1.52–6.55]). The combination of preoperative reduced haemoglobin and preoperative atrial fibrillation was a strong predictor (12.37 [4.40–34.77], p < .001). Estimated glomerular filtration rate (eGFR) predicted 30-d mortality in univariate models but was not an independent predictor in multivariate models. Conclusions. According to the main findings of our study, the combination of preoperative atrial fibrillation and reduced haemoglobin level substantially increase the risk of 30-d mortality after cardiac surgery. Identification of high-risk patients pre-operatively could help to make optimal clinical decisions for timing of operation and perioperative treatment.

中文翻译：

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术前房颤伴血红蛋白降低预示心脏手术后 30 天死亡率增加

摘要

目标

心房颤动是心脏手术后最​​常见的心律失常。较少关注术前房颤和贫血作为心脏手术后死亡的危险因素。本研究的目的是确定心脏直视手术后 30 天死亡率的术前危险因素。设计. 研究人群包括 2015 名接受冠状动脉旁路移植术 (CABG) (52.0%)、主动脉瓣置换术 (AVR) (18.6%)、AVR 和 CABG (10.0%)、二尖瓣的患者（73.4% 男性；平均年龄 68 岁） 2013 年 1 月至 2016 年 12 月在 Kuopio 大学医院进行瓣膜成形术或置换术 (14.0%)，以及 AVR 和主动脉根部重建 (ARR) (5.5%)。使用单变量和多变量 Cox 比例风险模型进行统计分析。生成了 Kaplan-Meier 生存曲线。结果。30 天总死亡率为 1.8%。通过 Cox 回归分析，30 天死亡率（风险比 [HR] [95% 置信区间 [CI]]）的预测因素包括女性（1.95 [1.00–3.77]）、术前房颤（2.38 [1.12–5.03] ) 降低的血红蛋白水平 (3.40 [1.47–7.90]) 和肺充血 (3.16 [1.52–6.55])。术前血红蛋白减少和术前心房颤动是一个强预测因子（12.37 [4.40–34.77]，p  < .001）。估计肾小球滤过率 (eGFR) 在单变量模型中预测 30 天死亡率，但在多变量模型中不是独立预测因子。结论。根据我们研究的主要发现，术前房颤和血红蛋白水平降低的结合显着增加了心脏手术后 30 天死亡的风险。术前识别高危患者有助于为手术时机和围手术期治疗做出最佳临床决策。