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Milrinone use is associated with postoperative atrial fibrillation after cardiac surgery.

Publication ,  Journal Article
Fleming, GA; Murray, KT; Yu, C; Byrne, JG; Greelish, JP; Petracek, MR; Hoff, SJ; Ball, SK; Brown, NJ; Pretorius, M
Published in: Circulation
October 14, 2008

BACKGROUND: Postoperative atrial fibrillation (AF), a frequent complication after cardiac surgery, causes morbidity and prolongs hospitalization. Inotropic drugs are commonly used perioperatively to support ventricular function. This study tested the hypothesis that the use of inotropic drugs is associated with postoperative AF. METHODS AND RESULTS: We evaluated perioperative risk factors in 232 patients who underwent elective cardiac surgery. All patients were in sinus rhythm at surgery. Sixty-seven patients (28.9%) developed AF a mean of 2.9+/-2.1 days after surgery. Patients who developed AF stayed in the hospital longer (P<0.001) and were more likely to die (P=0.02). Milrinone use was associated with an increased risk of postoperative AF (58.2% versus 26.1% in nonusers; P<0.001). Older age (63.4+/-10.7 versus 56.7+/-12.3 years; P<0.001), hypertension (P=0.04), lower preoperative ejection fraction (P=0.03), mitral valve surgery (P=0.02), right ventricular dysfunction (P=0.03), and higher mean pulmonary artery pressure (27.1+/-9.3 versus 21.8+/-7.5 mm Hg; P=0.001) also were associated with postoperative AF. In multivariable logistic regression, age (P<0.001), ejection fraction (P=0.02), and milrinone use (odds ratio, 4.86; 95% confidence interval, 2.31 to 10.25; P<0.001) independently predicted postoperative AF. When only data from patients with pulmonary artery catheters were analyzed and pulmonary artery pressure was included in the model, age, milrinone use (odds ratio, 4.45; 95% confidence interval, 2.01 to 9.84; P<0.001), and higher pulmonary artery pressure (P=0.02) were associated with an increased risk of postoperative AF. Adding other potential confounders or stratifying analysis by mitral valve surgery did not change the association of milrinone use with postoperative AF. CONCLUSIONS: Milrinone use is an independent risk factor for postoperative AF after elective cardiac surgery.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

October 14, 2008

Volume

118

Issue

16

Start / End Page

1619 / 1625

Location

United States

Related Subject Headings

  • Risk Factors
  • Pulmonary Wedge Pressure
  • Postoperative Complications
  • Multivariate Analysis
  • Mitral Valve Insufficiency
  • Milrinone
  • Middle Aged
  • Male
  • Logistic Models
  • Length of Stay
 

Citation

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Fleming, G. A., Murray, K. T., Yu, C., Byrne, J. G., Greelish, J. P., Petracek, M. R., … Pretorius, M. (2008). Milrinone use is associated with postoperative atrial fibrillation after cardiac surgery. Circulation, 118(16), 1619–1625. https://doi.org/10.1161/CIRCULATIONAHA.108.790162
Fleming, Gregory A., Katherine T. Murray, Chang Yu, John G. Byrne, James P. Greelish, Michael R. Petracek, Steven J. Hoff, Stephen K. Ball, Nancy J. Brown, and Mias Pretorius. “Milrinone use is associated with postoperative atrial fibrillation after cardiac surgery.Circulation 118, no. 16 (October 14, 2008): 1619–25. https://doi.org/10.1161/CIRCULATIONAHA.108.790162.
Fleming GA, Murray KT, Yu C, Byrne JG, Greelish JP, Petracek MR, et al. Milrinone use is associated with postoperative atrial fibrillation after cardiac surgery. Circulation. 2008 Oct 14;118(16):1619–25.
Fleming, Gregory A., et al. “Milrinone use is associated with postoperative atrial fibrillation after cardiac surgery.Circulation, vol. 118, no. 16, Oct. 2008, pp. 1619–25. Pubmed, doi:10.1161/CIRCULATIONAHA.108.790162.
Fleming GA, Murray KT, Yu C, Byrne JG, Greelish JP, Petracek MR, Hoff SJ, Ball SK, Brown NJ, Pretorius M. Milrinone use is associated with postoperative atrial fibrillation after cardiac surgery. Circulation. 2008 Oct 14;118(16):1619–1625.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

October 14, 2008

Volume

118

Issue

16

Start / End Page

1619 / 1625

Location

United States

Related Subject Headings

  • Risk Factors
  • Pulmonary Wedge Pressure
  • Postoperative Complications
  • Multivariate Analysis
  • Mitral Valve Insufficiency
  • Milrinone
  • Middle Aged
  • Male
  • Logistic Models
  • Length of Stay