Heart procedure choice affects irregular heartbeat risk, study finds
A Swedish analysis of nearly 7,000 heart patients reveals that minimally invasive coronary interventions trigger dangerous irregular heartbeats less often than traditional bypass surgery. The finding matters as hospitals and insurers weigh procedure costs against complication risks and long-term patient outcomes.
Originaltitel: Incidence of post-procedural atrial fibrillation after multivessel percutaneous coronary intervention versus coronary artery bypass grafting: a nationwide observational study.
# Kammarflimmer långt vanligare efter bypasskirurgi än invasiv koronarbehandling Multikärlsbehandling med kateter (MV-PCI) medför betydligt lägre risk för postoperativt kammarflimmer än bypasskirurgi (CABG). Svenska registerstudien följde 4 471 PCI-patienter och 2 232 CABG-patienter mellan 2013 och 2020. Kammarflimmer uppstod hos 0,6 procent efter PCI mot 5,7 procent efter CABG — en 15-faldig riskökning för kirurgi efter justering för ålder och sjukdomar. Trots detta skilde sig övriga komplikationer. Hjärtinfarkt var vanligare efter PCI (1,1 mot 0,4 procent), medan stroke förekommit oftare efter CABG (0,6 mot 0,3 procent). Dödlighet och allvarlig blödning skilde sig inte väsentligt mellan grupperna. Resultaten påverkar patienturvalsstrategier: CABG-patienter behöver proaktiv övervakning för arytmier och långtidsantikoagulation, medan PCI-säkerhetsprofilen gällande kammarflimmer stärks ytterligare.
BACKGROUND: Postoperative atrial fibrillation (AF) is a common complication after coronary artery bypass grafting (CABG) but is less well characterised after multivessel percutaneous coronary intervention (MV-PCI). With the increasing use of MV-PCI, we compared the incidence and clinical implications of clinically significant post-procedural AF following MV-PCI versus CABG. METHODS: In this nationwide observational study, we analysed data from the Swedish Coronary Angiography and Angioplasty Registry and the Swedish Prescribed Drug Register. We included all patients in Sweden with chronic coronary syndrome who underwent MV-PCI or isolated CABG between August 2013 and October 2020, excluding those with prior AF or oral anticoagulant (OAC) use in the preceding year. Clinically significant post-procedural AF was defined using a treatment-based proxy: a new OAC dispensation within 3 months after the procedure, with persistence at 9 months. The primary outcome was post-procedural AF incidence at 90 days; secondary outcomes were stroke, myocardial infarction, major bleeding and all-cause mortality. RESULTS: A total of 4471 patients undergoing MV-PCI and 2232 undergoing CABG were included. Post-procedural AF occurred in 0.6% after MV-PCI and 5.7% after CABG (adjusted risk ratio 15.02; 95% CI 8.72 to 25.87; p<0.001). MV-PCI patients were older and had more comorbidities, whereas CABG patients had higher rates of diabetes and more extensive coronary disease. At 90 days, all-cause mortality and major bleeding did not differ significantly. Myocardial infarction was more common after MV-PCI (1.1 vs 0.4%), whereas stroke was more frequent after CABG (0.6 vs 0.3%). CONCLUSIONS: Clinically significant post-procedural AF, defined by initiation and persistence of OAC therapy, was nearly tenfold more common after CABG than after MV-PCI. This association remained robust after multivariable adjustment for demographics, comorbidities and angiographic/severity-related factors. Differences in clinical outcomes were modest and should be interpreted cautiously.