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Postoperative atrial fibrillation (POAF) is the most common postoperative arrhythmia in patients undergoing isolated coronary artery bypass grafting (CABG); POAF is associated with an increased morbidity and mortality. Studies of treatments to reduce the risk of POAF have yielded conflicting results. We assessed the relationship of preoperative medication with POAF in patients undergoing isolated CABG.
This retrospective study, conducted from September to December 2014, included 226 consecutive patients without history of prior AF, scheduled for CABG at Clinical Centre of Serbia. All patients underwent continuous telemetry for ≥5 postoperative days (until discharge) and POAF was documented using 12-channel electrocardiography. The relationship of preoperative pharmacotherapy with the occurrence of POAF was investigated using univariate and multivariable Logistic regression analyses (adjusted for demographic characteristics, cardiovascular risk factors, and the type of CABG procedure).
Of 226 patients (mean age: 63.9±7.9 years, female n=54, 23.9%), 53 (23.5%) experienced ≥1 episode of POAF during in-hospital monitoring. Patients with POAF were older (65.8±7.3 vs. 63.4±8.0; p=0.049) and less often were taking statins preoperatively compared to non-POAF patients (n=39, 73.6% vs. n=137, 87.2%; p=0.030). There were no significant differences between the groups considering other preoperative factors (hypertension, diabetes, dyslipidemia, chronic lung disease, preoperative transient ischemic attack or cerebrovascular insult, peripheral arterial disease and smoking) or medications in POAF vs. non-POAF patients: amiodarone (n=4, 7.5% vs. n=11, 6.4%; p=0.756), beta-blockers (n=44, 83.0% vs. n=149, 86.1%; p=0.657), digoxin (n=0, 0.0% vs. n=1, 0.6%; p=1.000), diuretics (n=22, 41.5% vs. n=68, 39.3%; p=0.873), spironolactone (n=10, 18.9% vs. n=24, 13.9%; p=0.384), ACEi/ARBs (n=45, 84.9% vs. n=138, 79.8%; p=0.549), Ca-antagonists (n=14, 26.4% vs. n=43, 24.9%; p=0.857). In a multivariable analysis, preoperative statin use was associated with a 60% risk reduction in POAF incidence (Odds Ratio 0.41; 95% CI 0.19-0.87; p=0.020). In addition, there was no difference in the use of on-pump or off-pump surgery in the POAF vs. non-POAF group (p=0.450).
Our results suggest that preoperative use of statins may reduce the incidence of POAF in patients undergoing isolated CABG.