Thromboembolic and Mortality Risk in Patients with Postoperative Atrial Fibrillation After Coronary Artery Bypass Graft—The TRIP-AF Study

Background/Objectives: Postoperative atrial fibrillation (POAF) is a common complication of coronary artery bypass grafting (CABG) and may recur during cardiac rehabilitation (CR); its long-term prognostic value remains unclear. We evaluated the impact of POAF on a composite endpoint of all-cause mortality and non-fatal stroke after isolated CABG and assessed POAF duration and timing, AF recurrence, and other predictors of adverse outcomes. Methods: This multicentre retrospective study enrolled 1139 patients who underwent CR after isolated CABG between 2011 and 2015 across 17 Italian centres. Clinical and outcome data were obtained from medical records and structured interviews; median follow-up was 5.78 years. Results: POAF occurred in 34.3% of patients and was associated with a higher incidence of the primary composite endpoint of all-cause mortality and non-fatal stroke in univariate analysis (15.4% vs. 10.0%, p = 0.008), particularly when lasting ≥48 h or occurring during both surgery and rehabilitation. However, in multivariate analysis POAF was not an independent predictor; instead, CHA2DS2-VASc score ≥3, reduced left ventricular ejection fraction, elevated urea, history of heart failure, and AF recurrence during follow-up predicted adverse outcomes. Conclusions: POAF reflects early vulnerability but does not independently predict long-term mortality or stroke. Conversely, AF recurrence and CHA2DS2-VASc score retain strong prognostic value, underscoring the need for long-term rhythm monitoring and individualised risk assessment post-CABG.

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Journal
Journal of Clinical Medicine
Published
2026-09-29
DOI
https://doi.org/10.3390/jcm15197577
Primary Topic
Atrial Fibrillation Management and Outcomes
Type
article
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article

Thromboembolic and Mortality Risk in Patients with Postoperative Atrial Fibrillation After Coronary Artery Bypass Graft—The TRIP-AF Study

Franco Tarro Genta, Anna Frisinghelli, Maria De Salvo, Vittorio Racca et al.
Journal of Clinical Medicine
Atrial Fibrillation Management and Outcomes
article

Thromboembolic and Mortality Risk in Patients with Postoperative Atrial Fibrillation After Coronary Artery Bypass Graft—The TRIP-AF Study

Franco Tarro Genta, Anna Frisinghelli, Maria De Salvo, Vittorio Racca, Maria Teresa La Rovere, Elio Venturini, Emanuela Zanelli, Lia Crotti, Simona Sarzi Braga, Raffaella Vaninetti, Lucio Addeo, Laura Adelaide Dalla Vecchia, Vincenzo Rizza, Paola Grati, Simonetta Scalvini, Martina Passera, Roberto F.E. Pedretti, Gaia Cattadori, Niccolò Brenno Grieco, Anna Picozzi, Maurizio Bussotti, Andrea Passantino, Antimo Papa, Fabio Angeli, Angelo Caporotondi, Pasquale Campana, Mario Mallardo, Mario Facchini, Alfonso Galati, Maria Cristina Rossi, Valentina Cremona
article en

Abstract

Background/Objectives: Postoperative atrial fibrillation (POAF) is a common complication of coronary artery bypass grafting (CABG) and may recur during cardiac rehabilitation (CR); its long-term prognostic value remains unclear. We evaluated the impact of POAF on a composite endpoint of all-cause mortality and non-fatal stroke after isolated CABG and assessed POAF duration and timing, AF recurrence, and other predictors of adverse outcomes. Methods: This multicentre retrospective study enrolled 1139 patients who underwent CR after isolated CABG between 2011 and 2015 across 17 Italian centres. Clinical and outcome data were obtained from medical records and structured interviews; median follow-up was 5.78 years. Results: POAF occurred in 34.3% of patients and was associated with a higher incidence of the primary composite endpoint of all-cause mortality and non-fatal stroke in univariate analysis (15.4% vs. 10.0%, p = 0.008), particularly when lasting ≥48 h or occurring during both surgery and rehabilitation. However, in multivariate analysis POAF was not an independent predictor; instead, CHA2DS2-VASc score ≥3, reduced left ventricular ejection fraction, elevated urea, history of heart failure, and AF recurrence during follow-up predicted adverse outcomes. Conclusions: POAF reflects early vulnerability but does not independently predict long-term mortality or stroke. Conversely, AF recurrence and CHA2DS2-VASc score retain strong prognostic value, underscoring the need for long-term rhythm monitoring and individualised risk assessment post-CABG.

Journal of Clinical MedicineVol. 15(19)
University of Insubria (IT), University of Milan (IT), Regione Campania (IT), San Raffaele University of Rome (IT), Istituti Clinici Scientifici Maugeri (IT), MultiMedica (IT), Istituto Ortopedico Gaetano Pini (IT), Don Carlo Gnocchi Foundation (IT), Villa Pineta Hospital (IT), IRCCS Istituto Auxologico Italiano (IT), Ospedale di Mirano (IT), University of Milano-Bicocca (IT), University of Naples Federico II (IT)
Good health and well-being
Openalex Percentile: Top 11%
Atrial Fibrillation Management and Outcomes
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