Atrial fibrillation as a nonpsychiatric predictor of delirium after cardiac surgery: A pilot study

被引:0
作者
Banach, Maciej [1 ]
Kazilnierski, Jakub [2 ]
Kowman, Maciej [2 ]
Okonski, Piotr [3 ]
Sobow, Tomasz [3 ]
Kloszewska, Wona [3 ]
Mikhailidis, Dimitri P. [4 ]
Goch, Aleksander [1 ]
Banys, Andrzej [5 ]
Rysz, Jacek [6 ]
Goch, Jan Henryk [1 ]
Jaszewski, Ryszard [3 ]
机构
[1] Med Univ Lodz, Dept Cardiol, Chair Cardiol & Cardiac Surg 1, PL-91425 Lodz, Poland
[2] Med Univ Lodz, Dept Old Age Psychiat & Psychot Disorders, PL-91425 Lodz, Poland
[3] Med Univ Lodz, Dept Cardiac Surg, Chair Cardiol & Cardiac Surg 1, PL-91425 Lodz, Poland
[4] UCL, Royal Free Univ Coll Sch Med, Dept Clin Biochem, Vasc Dis Prevent Clin, London, England
[5] Med Univ Lodz, Dept Anesthesiol & Intens Cardiol Care, Chair Cardiol & Cardiac Surg 1, PL-91425 Lodz, Poland
[6] Med Univ Lodz, Dept Hypertens & Nephrol, PL-91425 Lodz, Poland
来源
MEDICAL SCIENCE MONITOR | 2008年 / 14卷 / 05期
关键词
atrial fibrillation; cardiac surgery; delirium; predictors; prognosis;
D O I
暂无
中图分类号
R-3 [医学研究方法]; R3 [基础医学];
学科分类号
1001 ;
摘要
Background: Preoperative atrial fibrillation (AF) increases the risk of cardiac surgery and the occurrence of post operative complications, including arrhythmias, low-output syndrome, delirium, and death. The aim was to evaluate its direct influence on prognosis of patients subjected to cardiac surgery. Material/Methods: his is a pilot study of the CODACS trial (COnsciousness Disorders After Cardiac Surgery). Two hundred sixty patients admitted for open-heart surgery were prospectively included in the study. Preoperative AF was diagnosed on the basis of multiple electrocardiographic examinations and confirmed by 24-h Holter monitoring. Diagnosis of delirium following surgical intervention was based on DSM-IV criteria. Results: Preoperative AF was diagnosed in 23 patients (8.8%): in 15 patients in the nondelirious group (7%) and 8 (27.0%) in the delirious group. Preoperative AF was an independent predictor of postoperative delirium (p<0.001), increasing its Fisk of occurrence over sevenfold (OR=7.2). AF also increased the risk of such postoperative complications as supraventricular arrhythmia (AF: 78.3% vs. non-AF: 22.8%, p<0.001), stroke (8.7% vs. 1.3%, p<0.001), and low-output syndrome (21.7% vs. 17.3%, p=0.033) and worsened prognosis, significantly increasing the Fisk of death (8.7% vs. 0.8%, p<0.001). Conclusions: Preoperative AF was an independent risk factor of postoperative delirium (OR=7.2). It was also associated with significantly worse postoperative outcome (supraventricular arrhythmia, stroke, low-output syndrome, and risk of death). These results and data from available studies suggest that preoperative AF should be considered as an important predictor of postoperative outcome. This problem should be the subject of future research to establish beneficial treatment options.
引用
收藏
页码:CR286 / CR291
页数:6
相关论文
共 32 条
[1]   Value of Preoperative Echocardiography in the prediction of postoperative atrial fibrillation following isolated coronary artery bypass grafting [J].
Acil, Tayfun ;
Colkesen, Yucel ;
Turkoz, Riza ;
Sezgin, Alpay Turan ;
Baltah, Mehmet ;
Gulcan, Oner ;
Demircan, Enol ;
Yildirir, Aylin ;
Ozin, Bulent ;
Muderrisoglu, Haldun .
AMERICAN JOURNAL OF CARDIOLOGY, 2007, 100 (09) :1383-1386
[2]  
[Anonymous], 1997, Diagnostic and Statistical Manual of Mental Disorders, Vfourth
[3]   Relation between postoperative mortality and atrial fibrillation before surgical revascularization - 3-year follow-up [J].
Banach, M. ;
Goch, A. ;
Misztal, M. ;
Rysz, J. ;
Zaslonka, J. ;
Goch, J. H. ;
Jaszewski, R. .
THORACIC AND CARDIOVASCULAR SURGEON, 2008, 56 (01) :20-23
[4]   Risk factors of atrial fibrillation following coronary artery bypass grafting - A preliminary report [J].
Banach, M ;
Rysz, J ;
Drozdz, J ;
Okonski, P ;
Misztal, M ;
Barylski, M ;
Irzmanski, R ;
Zaslonka, J .
CIRCULATION JOURNAL, 2006, 70 (04) :438-441
[5]  
BANACH M, 2005, CLIN EXP MED LETT, V48, P19
[6]  
Banach M, 2007, ARCH MED SCI, V3, pS126
[7]  
Banach M, 2007, ARCH MED SCI, V3, P229
[8]   Predictors of paroxysmal atrial fibrillation in patients undergoing aortic valve replacement [J].
Banach, Maciej ;
Goch, Aleksander ;
Misztal, Malgorzata ;
Rysz, Jacek ;
Jaszewski, Ryszard ;
Goch, Jan Henryk .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2007, 134 (06) :1569-1576
[9]  
Banach M, 2007, ARCH MED SCI, V3, P117
[10]   Predictors of delirium after cardiac surgery delirium: Effect of beating-heart (off-pump) surgery [J].
Bucerius, J ;
Gummert, JF ;
Borger, MA ;
Walther, T ;
Doll, N ;
Falk, V ;
Schmitt, DV ;
Mohr, FW .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2004, 127 (01) :57-64