Mohammed A Quader, MD, Patrick M McCarthy, MD, A

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Presentation transcript:

Does preoperative atrial fibrillation reduce survival after coronary artery bypass grafting? Mohammed A Quader, MD, Patrick M McCarthy, MD, A.Marc Gillinov, MD, Joan M Alster, MS, Delos M Cosgrove, MD, Bruce W Lytle, MD, Eugene H Blackstone, MD The Annals of Thoracic Surgery Volume 77, Issue 5, Pages 1514-1524 (May 2004) DOI: 10.1016/j.athoracsur.2003.09.069

Fig 1 Prevalence of preoperative atrial fibrillation (AF) according to age (A), body surface area (BSA; B), year of operation (C), and cholesterol level (D). Circles represent observed prevalence of atrial fibrillation and the solid line is a trend line. The Annals of Thoracic Surgery 2004 77, 1514-1524DOI: (10.1016/j.athoracsur.2003.09.069)

Fig 2 Survival after coronary artery bypass grafting in unmatched groups according to presence (AF) or absence (No AF) of preoperative atrial fibrillation. Symbols are Kaplan-Meier estimates at 5-year intervals with 68% confidence limits indicated by vertical bars. Numbers of patients remaining at risk are shown in parentheses. Solid lines represent parametric survival estimates and are enclosed within 68% confidence limits (dashed lines) equivalent to one standard error. Because of both higher mortality and few patients, reliable estimates of survival among patients with atrial fibrillation could not be obtained beyond approximately 15 years. Survival in patients without atrial fibrillation is nevertheless depicted to show that approximately equivalent survival occurs more than 10 years after patients in atrial fibrillation. The Annals of Thoracic Surgery 2004 77, 1514-1524DOI: (10.1016/j.athoracsur.2003.09.069)

Fig 3 (A) Survival after coronary artery bypass grafting in propensity-matched groups of patients with (AF) and without (No AF) preoperative atrial fibrillation. Symbols are Kaplan-Meier estimates at 5-year intervals with 68% confidence limits indicated by vertical bars. Numbers of patients remaining at risk are shown in parentheses. Solid linesrepresent parametric survival estimates and are enclosed within 68% confidence limits (dashed lines) equivalent to one standard error. Reliable estimates for patients without preoperative atrial fibrillation extend to 20 years, illustrating approximately equivalent survival more than 5 years after those with atrial fibrillation. (B) Difference in percent survival (solid line) between survival of patients with and without preoperative atrial fibrillation is shown enclosed within 90% confidence limits (dashed lines). The horizontal axis extends only to 15 years, after which reliable estimates of difference could not be obtained. The Annals of Thoracic Surgery 2004 77, 1514-1524DOI: (10.1016/j.athoracsur.2003.09.069)

Fig 4 (A) Instantaneous risk of death (hazard function) after coronary artery bypass grafting in propensity-matched groups of patients with (AF) and without (No AF) preoperative atrial fibrillation. Hazard functions are represented as solid lines enclosed within dashed 68% confidence limits. (B) For the hazard ratio, a value of 1 indicates equal hazard. Values above 1 indicate increased hazard for patients with preoperative atrial fibrillation. Dashed lines are 90% confidence limits. The horizontal axis extends only to 15 years, after which reliable estimates of the hazard ratio could not be obtained. The Annals of Thoracic Surgery 2004 77, 1514-1524DOI: (10.1016/j.athoracsur.2003.09.069)

Fig 5 Cost of preoperative atrial fibrillation (AF) expressed as decreased lifetime (area between survival curves shown in Fig 3A). Dashed lines are 90% confidence limits. The horizontal axis extends only to 15 years, after which reliable estimates of difference in lifetime could not be obtained. The Annals of Thoracic Surgery 2004 77, 1514-1524DOI: (10.1016/j.athoracsur.2003.09.069)