Abstract

Surgical intervention in the setting of cardiogenic shock (CS) is burdened with high mortality. Due to acute condition, detailed diagnoses and risk assessment is often precluded. Atrial fibrillation (AF) is a risk factor for perioperative complications and worse survival but little is known about AF patients operated in CS. Current analysis aimed to determine prognostic impact of preoperative AF in patients undergoing heart surgery in CS. We analyzed data from the Polish National Registry of Cardiac Surgery (KROK) Procedures. Between 2012 and 2021, 332,109 patients underwent cardiac surgery in 37 centers; 4852 (1.5%) patients presented with CS. Of those 624 (13%) patients had AF history. Cox proportional hazards models were used for computations. Propensity score (nearest neighbor) matching for the comparison of patients with and without AF was performed. Median follow-up was 4.6 years (max.10.0), mean age was 62 (± 15) years and 68% patients were men. Thirty-day mortality was 36% (1728 patients). The origin of CS included acute myocardial infarction (1751 patients, 36%), acute aortic dissection (1075 patients, 22%) and valvular dysfunction (610 patients, 13%). In an unadjusted analysis, patients with underlying AF had almost 20% higher mortality risk (HR 1.19, 95% CIs 1.06–1.34; P = 0.004). Propensity score matching returned 597 pairs with similar baseline characteristics; AF remained a significant prognostic factor for worse survival (HR 1.19, 95% CI 1.00–1.40; P = 0.045). Among patients with CS referred for cardiac surgery, history of AF was a significant risk factor for mortality. Role of concomitant AF ablation and/or left atrial appendage occlusion or more aggressive perioperative circulatory support should be addressed in the future.

Details

Title
Prognostic impact of preoperative atrial fibrillation in patients undergoing heart surgery in cardiogenic shock
Author
Kowalewski, Mariusz 1 ; Raffa, Giuseppe M. 2 ; Pasierski, Michał 3 ; Kołodziejczak, Michalina 4 ; Litwinowicz, Radosław 5 ; Wańha, Wojciech 6 ; Wojakowski, Wojciech 7 ; Rogowski, Jan 8 ; Jasiński, Marek 9 ; Widenka, Kazimierz 10 ; Hirnle, Tomasz 11 ; Deja, Marek 12 ; Bartus, Krzysztof 13 ; Lorusso, Roberto 14 ; Tobota, Zdzisław 15 ; Maruszewski, Bohdan 15 ; Suwalski, Piotr 3 ; Anisimowicz, Lech 16 ; Biederman, Andrzej 17 ; Borkowski, Dariusz 18 ; Brykczyński, Mirosław 19 ; Bugajski, Paweł 20 ; Burysz, Marian 21 ; Cholewiński, Paweł 22 ; Cichoń, Romuald 23 ; Cisowski, Marek 24 ; Dziatkowiak, Antoni 25 ; Gburek, Tadeusz 26 ; Gerber, Witold 24 ; Gryszko, Leszek 27 ; Haponiuk, Ireneusz 28 ; Hendzel, Piotr 29 ; Jabłonka, Stanisław 30 ; Jarmoszewicz, Krzysztof 31 ; Jaszewski, Ryszard 32 ; Jemielity, Marek 33 ; Kalawski, Ryszard 34 ; Kapelak, Bogusław 25 ; Karolczak, Maciej A. 35 ; Kaperczak, Jacek 36 ; Knapik, Piotr 37 ; Krejca, Michał 32 ; Kustrzycki, Wojciech 38 ; Kuśmierczyk, Mariusz 39 ; Kwinecki, Paweł 40 ; Markuszewski, Leszek 41 ; Missima, Maurycy 42 ; Moll, Jacek J. 43 ; Ogorzeja, Wojciech 44 ; Pająk, Jacek 35 ; Pawliszak, Wojciech 16 ; Pietrzyk, Edward 45 ; Religa, Grzegorz 46 ; Różański, Jacek 47 ; Sadowski, Jerzy 25 ; Sharma, Girish 40 ; Skalski, Janusz 48 ; Skiba, Jacek 49 ; Stanisławski, Ryszard 50 ; Stążka, Janusz 30 ; Stec, Sebastian 51 ; Stępiński, Piotr 50 ; Suwalski, Grzegorz 27 ; Suwalski, Kazimierz 27 ; Tułecki, Łukasz 52 ; Wierzba, Waldemar 27 ; Wojtalik, Michał 53 ; Woś, Stanisław 54 ; Zembala, Michał Oskar 55 ; Żelazny, Piotr 56 

1  National Medical Institute of the Ministry of Interior and Administration, Clinical Department of Cardiac Surgery and Transplantology, Centre of Postgraduate Medical Education, Warsaw, Poland (GRID:grid.436113.2); Maastricht University Medical Centre, Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht, The Netherlands (GRID:grid.412966.e) (ISNI:0000 0004 0480 1382); IRCCS-ISMETT, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Palermo, Italy (GRID:grid.412966.e); Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Thoracic Research Centre, Bydgoszcz, Poland (GRID:grid.411797.d) (ISNI:0000 0001 0595 5584) 
2  IRCCS-ISMETT, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Palermo, Italy (GRID:grid.411797.d); Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Thoracic Research Centre, Bydgoszcz, Poland (GRID:grid.411797.d) (ISNI:0000 0001 0595 5584) 
3  National Medical Institute of the Ministry of Interior and Administration, Clinical Department of Cardiac Surgery and Transplantology, Centre of Postgraduate Medical Education, Warsaw, Poland (GRID:grid.436113.2); Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Thoracic Research Centre, Bydgoszcz, Poland (GRID:grid.411797.d) (ISNI:0000 0001 0595 5584) 
4  Nicolaus Copernicus University, Department of Anaesthesiology and Intensive Care, Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland (GRID:grid.5374.5) (ISNI:0000 0001 0943 6490); Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Thoracic Research Centre, Bydgoszcz, Poland (GRID:grid.411797.d) (ISNI:0000 0001 0595 5584) 
5  Regional Specialist Hospital, Department of Cardiac Surgery, Grudziądz, Poland (GRID:grid.411797.d); Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Thoracic Research Centre, Bydgoszcz, Poland (GRID:grid.411797.d) (ISNI:0000 0001 0595 5584) 
6  Medical University of Silesia, Department of Cardiology and Structural Heart Diseases, Katowice, Poland (GRID:grid.411728.9) (ISNI:0000 0001 2198 0923); Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Thoracic Research Centre, Bydgoszcz, Poland (GRID:grid.411797.d) (ISNI:0000 0001 0595 5584) 
7  Medical University of Silesia, Department of Cardiology and Structural Heart Diseases, Katowice, Poland (GRID:grid.411728.9) (ISNI:0000 0001 2198 0923) 
8  Medical University of Gdansk, Department of Cardiac and Vascular Surgery, Gdansk, Poland (GRID:grid.11451.30) (ISNI:0000 0001 0531 3426) 
9  Wroclaw Medical University, Department and Clinic of Cardiac Surgery, Wroclaw, Poland (GRID:grid.4495.c) (ISNI:0000 0001 1090 049X) 
10  University of Rzeszów, Clinical Department of Cardiac Surgery, District Hospital No. 2, Rzeszów, Poland (GRID:grid.13856.39) (ISNI:0000 0001 2154 3176) 
11  Medical University of Bialystok, Department of Cardiosurgery, Bialystok, Poland (GRID:grid.48324.39) (ISNI:0000 0001 2248 2838) 
12  Upper-Silesian Heart Center, Department of Cardiac Surgery, Katowice, Poland (GRID:grid.411728.9) (ISNI:0000 0001 2198 0923) 
13  Regional Specialist Hospital, Department of Cardiac Surgery, Grudziądz, Poland (GRID:grid.411728.9) 
14  Maastricht University Medical Centre, Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht, The Netherlands (GRID:grid.412966.e) (ISNI:0000 0004 0480 1382) 
15  The Children’s Memorial Health Institute, Department of Pediatric Cardiothoracic Surgery, Warsaw, Poland (GRID:grid.413923.e) (ISNI:0000 0001 2232 2498) 
16  University Hospital, Department of Cardiac Surgery, Bydgoszcz, Poland (GRID:grid.412700.0) (ISNI:0000 0001 1216 0093) 
17  Medicover Hospital, Cardiac Surgery Department, Warsaw, Poland (GRID:grid.412700.0) 
18  Masovian Specialistic Hospital of Radom, Department of Cardiac Surgery, Radom, Poland (GRID:grid.412700.0) 
19  Pomeranian Medical University, Department of Cardiac Surgery, Szczecin, Poland (GRID:grid.107950.a) (ISNI:0000 0001 1411 4349) 
20  J. Struś Hospital, Department of Cardiosurgery, Poznań, Poland (GRID:grid.107950.a) 
21  Regional Specialist Hospital, Department of Cardiac Surgery, Grudziądz, Poland (GRID:grid.107950.a) 
22  Masovian Specialistic Hospital of Radom, Department of Cardiac Surgery, Radom, Poland (GRID:grid.107950.a) 
23  Medinet Heart Center Ltd, Department of Cardiac Surgery, Wroclaw, Poland (GRID:grid.520373.0) (ISNI:0000 0005 0267 5850); University Clinical Center of the Medical University of Warsaw, Department of Cardiovascular Surgery, Warsaw, Poland (GRID:grid.13339.3b) (ISNI:0000 0001 1328 7408) 
24  American Heart of Poland, Department of Cardiac Surgery, Bielsko-Biała, Poland (GRID:grid.460325.6) 
25  Jagiellonian University Medical College, John Paul II Hospital, Department of Cardiovascular Surgery and Transplantology, Krakow, Poland (GRID:grid.5522.0) (ISNI:0000 0001 2162 9631) 
26  The Pope John Paul II Province Hospital, Department of Cardiac Surgery, Zamość, Poland (GRID:grid.5522.0) 
27  Military Institute of Medicine, Department of Cardiac Surgery, Warsaw, Poland (GRID:grid.415641.3) (ISNI:0000 0004 0620 0839) 
28  Pomeranian Traumatology Center, Department of Pediatric Cardiac Surgery, Gdańsk, Poland (GRID:grid.415641.3) 
29  Medical University of Warsaw, Warsaw, Poland (GRID:grid.13339.3b) (ISNI:0000000113287408) 
30  Medical University of Lublin, Cardiac Surgery Department, Lublin, Poland (GRID:grid.411484.c) (ISNI:0000 0001 1033 7158) 
31  Ceynowa Specialist Hospital in Wejherowo, Department of Cardiac Surgery, Wejherowo, Poland (GRID:grid.411484.c) 
32  Medical University of Lodz, Department of Cardiac Surgery, Lodz, Poland (GRID:grid.8267.b) (ISNI:0000 0001 2165 3025) 
33  Poznan University of Medical Sciences, Department of Cardiac Surgery and Transplantology, Poznań, Poland (GRID:grid.22254.33) (ISNI:0000 0001 2205 0971) 
34  J. Struś Hospital, Department of Cardiosurgery, Poznań, Poland (GRID:grid.22254.33) 
35  Medical University of Warsaw, Department of Cardiac and General Pediatric Surgery, Warsaw, Poland (GRID:grid.13339.3b) (ISNI:0000 0001 1328 7408) 
36  University Hospital, University of Opole, Department of Cardiac Surgery, Institute of Medical Sciences, Opole, Poland (GRID:grid.107891.6) (ISNI:0000 0001 1010 7301) 
37  Medical University of Silesia, Department of Anesthesiology and Intensive Therapy, Silesian Centre for Heart Diseases in Zabrze, Katowice, Poland (GRID:grid.411728.9) (ISNI:0000 0001 2198 0923) 
38  Wroclaw Medical University, Department of Cardiac Surgery, Wroclaw, Poland (GRID:grid.4495.c) (ISNI:0000 0001 1090 049X) 
39  University Clinical Center of the Medical University of Warsaw, Department of Cardiovascular Surgery, Warsaw, Poland (GRID:grid.13339.3b) (ISNI:0000 0001 1328 7408) 
40  Medinet Heart Center Ltd, Department of Cardiac Surgery, Wroclaw, Poland (GRID:grid.520373.0) (ISNI:0000 0005 0267 5850) 
41  Kazimierz Pulaski University of Technology and Humanities in Radom, Department of Medicine, Faculty of Medical Sciences and Health Sciences, Radom, Poland (GRID:grid.445356.5) (ISNI:0000 0001 2152 5584) 
42  11th Military Research Hospital and Polyclinic IPHC in Bydgoszcz, Cardiology and Cardiac Surgery Department, Bydgoszcz, Poland (GRID:grid.445356.5) 
43  Polish Mother’s Memorial Hospital Research Institute, Department of Cardiac Surgery, Lodz, Poland (GRID:grid.415071.6) (ISNI:0000 0004 0575 4012) 
44  Regional Specialist Hospital, Department of Cardiac Surgery, Grudziądz, Poland (GRID:grid.415071.6) 
45  Department of Cardiac Surgery, Swietokrzyskie Cardiology Center, Kielce, Poland (GRID:grid.412700.0) 
46  Bieganski Hospital, Department of Cardiac Surgery, Łódź, Poland (GRID:grid.412700.0) 
47  National Institute of Cardiology, Department of Cardiac Surgery and Transplantology, Warsaw, Poland (GRID:grid.418887.a) 
48  Jagiellonian University, Pediatric Cardiac Surgery, Krakow, Poland (GRID:grid.5522.0) (ISNI:0000 0001 2337 4740) 
49  4Th Military Hospital, Department of Cardiac Surgery, Wrocław, Poland (GRID:grid.415590.c) 
50  Lower Silesian Center for Heart Diseases, Nowa Sól, Poland (GRID:grid.419246.c) (ISNI:0000 0004 0485 8725) 
51  Subcarpathian Center for Cardiovascular Intervention, Sanok, Poland (GRID:grid.411484.c) 
52  The Pope John Paul II Province Hospital, Department of Cardiac Surgery, Zamość, Poland (GRID:grid.415641.3) 
53  Poznan University of Medical Sciences, Department of Paediatric Cardiac Surgery, Poznań, Poland (GRID:grid.22254.33) (ISNI:0000 0001 2205 0971) 
54  Medical University of Silesia, 2nd Department of Cardiac Surgery, Katowice, Poland (GRID:grid.411728.9) (ISNI:0000 0001 2198 0923) 
55  Silesian Center for Heart Disease, Division of Cardiac Surgery, Heart and Lung Transplantation and Mechanical Circulatory Support, Zabrze, Poland (GRID:grid.419246.c) (ISNI:0000 0004 0485 8725) 
56  Voivodeship Specialist Hospital of Olsztyn, Department of Cardiac Surgery, Olsztyn, Poland (GRID:grid.419246.c) 
Pages
21818
Publication year
2023
Publication date
2023
Publisher
Nature Publishing Group
e-ISSN
20452322
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1038/s41598-023-47642-3
ProQuest document ID
2899737823
Copyright
© The Author(s) 2023. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.