국민건강보험공단 빅데이터를 이용한 심장판막 수술을 시행한 환자에서 심방세동의 수술적 치료에 따른 결과 비교 연구

Abstract

OBJECTIVES: This study aimed to compare the clinical outcomes between the patients with preoperative atrial fibrillation (AF) who underwent aortic (AV) or mitral valve (MV) surgeries with and without surgical ablation of AF in a national administrative claims database. METHODS: In the Korean National Health Insurance Service database, 17,247 patients with preoperative AF who underwent AV/MV surgery between January 2003 and December 2018 were retrieved. Among these patients, 8,716 received surgical AF ablation (Ablation group), whereas 8,531 did not (No-Ablation group). The comparative risks of mortality, and stroke or systemic embolization between the two groups were evaluated after adjusting with inverse-probability-of-treatment weighting (IPTW). RESULTS: Adjustment with IPTW yielded the study cohorts that were well-balanced for baseline and operative profiles. During a follow-up of 124,842.2 patient-years (PY), death occurred in 1,597 patients (2.65/patient-year [PY]) in the Ablation group and 2,628 (4.08/PY) in the No-Ablation group; stroke or systemic embolization occurred in 505 in the Ablation group and 875 in the No-Ablation group. The adjusted risk of mortality (hazard ratio [HR], 0.86; 95% confidence interval [CI] 0.80-0.92; P < 0.001) and stroke or systemic embolization (HR, 0.62; 95% CI 0.56-0.69; P < 0.001) was significantly lower in the Ablation group than the No-Ablation group. CONCLUSIONS: Concomitant surgical AF ablation in patients undergoing AV/MV surgery significantly lowered the risk of mortality and stroke or systemic embolization.