摘要目的:探讨心脏手术后心房颤动(postoperative atrial fibrillation, POAF)和心脏术后迟发性心房颤动(delayed-onset postoperative atrial fibrillation, dPOAF)的危险因素和预后分析。方法:采用多中心回顾性、观察性队列研究，收集2015年1月至2022年12月在江苏省57家医院接受心脏手术患者的临床资料。随访结束日期2023年6月30日。研究终点事件为全因病死率、主要不良心血管事件(MACEs)和血栓栓塞事件。按照术后新发房颤的发生时间将患者分为住院POAF组和dPOAF组，比较两组临床资料差异。采用多变量逻辑回归和 Cox比例风险回归模型，评估dPOAF的潜在风险因素和预后。本研究中的dPOAF定义为患者出院后30天内新出现的房颤。 结果:研究共观察到2 788例术后新发POAF患者，其中154例(5.5%)出现dPOAF，术后中位发生时间21(15，26)天。与住院期间诊断的POAF相比，dPOAF与高血压病(28.6%对9.0%， P<0.001)、糖尿病(10.4%对3.2%， P<0.001)、心力衰竭(39.6%对19.3%， P<0.001)、外周血管疾病(13.6%对2.2%， P<0.001)和较高的CHA2DS2-VASc评分(≥2分)(59.8%对43.2%， P<0.001)相关。女性患者发生dPOAF( OR＝0.44，95% CI：0.30～0.63， P<0.001)比例较少。随访期间，dPOAF与MACEs( HR＝1.33，95% CI：0.82～2.17)、总体病死率( HR＝0.58，95% CI：0.07～4.67)、血栓栓塞事件( HR＝0.57，95% CI：0.26～1.25)的发生无相关性。 结论:dPOAF和住院POAF的发生风险因素和预后差异无统计学意义。dPOAF会增加出院患者的病死率及相关不良事件发生率，对出院患者进行dPOAF监测治疗可以改善预后。男性和较高的CHA2DS2-VASc评分(≥2分)是dPOAF发病的独立风险因素，应对dPOAF患者进行严格监测和个体化管理。

abstractsObjective:To investigate the risk factors and prognosis of postoperative atrial fibrillation(POAF) and delayed-onset POAF(dPOAF).Methods:In a retrospective cohort study involving consecutive patients who underwent cardiac surgery across provincial cardiovascular consortium consisted of 57 hospitals in Jiangsu Province from January 2015 to December 2022, the incidence and implications of dPOAF were examined. dPOAF was defined as being diagnosed within 30 days of discharge.Results:Among 2 788 patients with postoperative new-onset POAF, 154(5.5%)cases had dPOAF, median onset time 21(15, 26)days following surgery. Compared to in-patient diagnosed POAF, dPOAF was associated with increased rates of hypertension(28.6% vs. 9.0%, P<0.001), diabetes(10.4% vs. 3.2%, P<0.001), heart failure(39.6% vs. 19.3%, P<0.001), peripheral vascular disease(13.6% vs. 2.2%, P<0.001), and higher CHA2DS2-VASc score(≥2)(59.8% vs. 43.2%, P<0.001). Female patients were less likely to develop dPOAF( OR=0.44, 95% CI: 0.30-0.63, P<0.001). During follow-up period, there was no significant difference in major adverse cardiovascular events(MACEs)( HR=1.33, 95% CI: 0.82-2.17), overall mortality( HR=0.58, 95% CI: 0.07-4.67), or thromboembolism events( HR=0.57, 95% CI: 0.26-1.25). Conclusion:This study underscores the risk factors and prognosis associated with dPOAF compared to in-hospital POAF. It highlights the imperative for vigilant monitoring and individualized management strategies tailored to patients at risk of dPOAF.