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[JAMA Netw Open发表论文]:性别、房颤与心脏外科术后远期病死率
2024年12月05日 时讯速递, 进展交流 [JAMA Netw Open发表论文]:性别、房颤与心脏外科术后远期病死率已关闭评论

Original Investigation 

Cardiology

August 21, 2024

Sex, Atrial Fibrillation, and Long-Term Mortality After Cardiac Surgery

Sergey Karamnov, Natalia Sarkisian, Jakob Wollborn, et al

JAMA Netw Open. 2024;7(8):e2426865. doi:10.1001/jamanetworkopen.2024.26865

Key Points

Question  Do the incidence of postoperative atrial fibrillation (poAF) and associated long-term mortality after cardiac surgery differ by sex?

Findings  In a cohort study of 21 568 patients who underwent open heart surgery, controlling for patient and surgery-related risk factors, women had a significantly lower incidence of poAF than men, but poAF was associated with significantly higher adjusted mortality hazard in women compared with men.

Meaning  These findings suggest that more vigilant monitoring and long-term follow-up care for women who develop poAF after cardiac surgery are warranted.

Abstract

Importance  There are limited data on the association of sex with the incidence of postoperative atrial fibrillation (poAF) and subsequent long-term mortality after cardiac surgery.

Objective  To evaluate whether the incidence of poAF and associated long-term mortality after cardiac surgery differ by sex.

Design, Setting, and Participants  This retrospective cohort study was conducted at 2 tertiary care centers in Massachusetts from January 1, 2002, until October 1, 2016, with follow-up until December 1, 2022. Adult (aged >20 years) women and men undergoing coronary artery bypass graft surgery, aortic valve surgery, mitral valve surgery, and combined procedures with cardiopulmonary bypass were examined using medical records. Patients who had data on poAF were included in data analyses.

Exposures  Sex and poAF.

Main Outcomes and Measures  Primary outcomes were the incidence of poAF and all-cause mortality. poAF was defined as any atrial fibrillation detected on electrocardiogram (EKG) during the index hospitalization in patients presenting for surgery in normal sinus rhythm. Data on poAF were obtained from EKG reports and supplemented by information from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. All-cause mortality was assessed via hospital records. The hypotheses were formulated prior to data analysis.

Results  Among 21 568 patients with poAF data (mean [SD] age, 66.5 [12.4] years), 2694 of 6601 women (40.8%) and 5805 of 14 967 men (38.8%) developed poAF. In a multivariable logistic regression model, women had lower risk of poAF (odds ratio [OR], 0.85; 95% CI, 0.79-0.91; P < .001). During the follow-up study period, 1294 women (50.4%) and 2376 men (48.9%) in the poAF group as well as 1273 women (49.6%) and 2484 men (51.1%) in the non-poAF group died. Cox proportional hazards analysis found that the association between poAF and mortality was significantly moderated (ie, effect modified) by sex. Compared with same-sex individuals without poAF, men with poAF had a 17% higher mortality hazard (hazard ratio [HR], 1.17; 95% CI, 1.11-1.25; P < .001), and women with poAF had a 31% higher mortality hazard (HR, 1.31; 95% CI, 1.21-1.42; P < .001).

Conclusions and Relevance  In this retrospective cohort study of 21 568 patients who underwent cardiac surgery, women were less likely to develop poAF than men when controlling for other relevant characteristics; however, women who did develop poAF had a higher risk of long-term mortality than men who developed poAF. This observed elevated risk calls for a tailored approach to perioperative care in women undergoing cardiac surgery.

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