# Postoperative Atrial Fibrillation Impacted by Completeness of Coronary Revascularization and Antiplatelet Regimen

## TL;DR

This study shows that incomplete heart surgery and use of clopidogrel increase the risk of post-surgery heart rhythm problems.

## Contribution

The study reveals that antiplatelet drug choice modifies the impact of revascularization completeness on postoperative atrial fibrillation.

## Key findings

- Incomplete revascularization increased POAF risk by 70% compared to complete revascularization.
- Clopidogrel users with incomplete revascularization had higher POAF rates than ticagrelor users.
- Incomplete revascularization was linked to higher inflammation and longer hospital stays.

## Abstract

Postoperative atrial fibrillation (POAF) is a common complication after off‐pump coronary artery bypass grafting (OPCABG) and contributes to increased morbidity and prolonged hospital stays. Both myocardial ischemia and systemic inflammation play a critical role in its pathogenesis, which is closely related to the intensity of coronary revascularization and antiplatelet treatment, respectively.

This study investigated the impact of the interaction between completeness of coronary revascularization and antiplatelet regimen on POAF incidence.

A total of 505 eligible patients, undergoing elective first‐time OPCABG surgery from May 2017 to May 2024, were reviewed and divided into the incomplete revascularization (IR) group (n = 143) and complete revascularization (CR) group (n = 362) according to the extent of coronary revascularization. The incidence of POAF within the first week post‐OPCABG was 39.2% in the IR group versus 25.1% in the CR group (hazard ratio [HR]: 1.70, 95% confidence interval [CI]: 1.18–2.46; p = 0.002). AF burden (10.1% [IQR 4.8%, 16.5%] vs. 6.0% [IQR 2.3%, 9.5%], p = 0.003), inflammatory markers (interleukin‐6 [IL‐6] on Day 1: 104 ± 20 vs. 98 ± 16 pg/mL, p < 0.001), markers of prothrombotic state (D‐dimer on Day 5: 2.6 ± 0.7 mg/L FEU vs. 2.3 ± 0.7 mg/L FEU, p < 0.001), and postoperative hospital stay (10.7 ± 1.8 vs. 10.3 ± 1.8 days, p = 0.006) were significantly higher in the IR group compared to the CR group. Among patients receiving clopidogrel, POAF incidence was 42.6% (IR) vs. 25.9% (CR) (p = 0.001). Among patients receiving ticagrelor, POAF incidence was 25.0% (IR) vs. 22.5% (CR).

IR was associated with a higher rate of POAF after OPCABG in patients receiving clopidogrel‐based DAPT, but not in those receiving ticagrelor‐based DAPT.