Risk of stroke and other adverse outcomes in patients with perioperative atrial fibrillation 1 year after non-cardiac surgery

Conen D 1 , Alonso-Coello P 2 , Douketis J 3 , Chan MTV 4 , Kurz A 5 , Sigamani A 6 Show all authors , Parlow JL 7 , Wang CY 8 , Villar JC 9 , Srinathan SK 10 , Tiboni M 3 , Malaga G 11 , Guyatt G 3 , Sivakumaran S 12 , Rodriguez Funes MV 13 , Cruz P 14 , Yang H 15 , Dresser GK 16 , Alvarez-Garcia J 17 , Schricker T 18 , Jones PM 15 , Drummond LW 19 , Balasubramanian K 1 , Yusuf S 1 , Devereaux PJ 1

Affiliations 

  • 1 Population Health Research Institute, McMaster University, Hamilton, Canada
  • 2 Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton L8S 4K1, Canada
  • 3 Department of Medicine, McMaster University, 1280 Main St W, Hamilton L8S 4K1, Canada
  • 4 Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong Special administrative Region, China
  • 5 Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44120, USA
  • 6 Department of Clinical Research, Narayana Hrudayalaya Limited, 258/A, Hosur Road, Bommasandra Industrial Area, Anekal Taluk, Bangalore 560099, India
  • 7 Department of Anesthesiology and Perioperative Medicine, Kingston Health Sciences Centre and Queen's University, 76 Stuart St, Kingston, ON K7L 2V7, Canada
  • 8 Department of Anesthesiology, University of Malaya, 50603 Kuala Lumpur, Malaysia
  • 9 Departamento de Investigaciones, Fundación Cardioinfantil -Instituto de Cardiología and Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Av. 42 ##48 - 11, Bucaramanga, Santander, Colombia
  • 10 Department of Surgery, University of Manitoba, Rm. GE61, 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada
  • 11 School of Medicine, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martín de Porres 15102, Lima, Peru
  • 12 Department of Medicine, University of Alberta, 116 St & 85 Ave, Edmonton, AB T6G 2R3, Canada
  • 13 Unidad de Investigacion Cientifica, Facultad de Medicina, Universidad de El Salvador, Final 25 Ave norte, San Salvador, El Salvador
  • 14 Department of Anesthesia, Hospital General Universitario Gregorio Marañon, Calle del Dr. Esquerdo 46, 28007 Madrid, Spain
  • 15 Department of Anesthesia & Perioperative Medicine, University of Western Ontario, 1151 Richmond St, London, ON N6A 3K7, Canada
  • 16 Department of Medicine, London Health Sciences Centre, Victoria Hospital, 800 Commissioners Rd E, London, ON N6A 5W9, Canada
  • 17 Department of Cardiology, Hospital de la Santa Creu i Sant Pau, CIBERCV, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autonoma de Barcelona, Carrer de Sant Quintí, 89, 08041 Barcelona, Spain
  • 18 Department of Anesthesia, McGill University Health Centre, McGill University, 1001 Decarie Blvd, Montreal, QC H4A 3J1, Canada
  • 19 Department of Anaesthesia, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, 719 Umbilo Road, Umbilo, 4001, South Africa
Eur Heart J, 2020 02 01;41(5):645-651.
PMID: 31237939 DOI: 10.1093/eurheartj/ehz431

Abstract

AIMS: To determine the 1-year risk of stroke and other adverse outcomes in patients with a new diagnosis of perioperative atrial fibrillation (POAF) after non-cardiac surgery.

METHODS AND RESULTS: The PeriOperative ISchemic Evaluation (POISE)-1 trial evaluated the effects of metoprolol vs. placebo in 8351 patients, and POISE-2 compared the effect of aspirin vs. placebo, and clonidine vs. placebo in 10 010 patients. These trials included patients with, or at risk of, cardiovascular disease who were undergoing non-cardiac surgery. For the purpose of this study, we combined the POISE datasets, excluding 244 patients who were in atrial fibrillation (AF) at the time of randomization. Perioperative atrial fibrillation was defined as new AF that occurred within 30 days after surgery. Our primary outcome was the incidence of stroke at 1 year of follow-up; secondary outcomes were mortality and myocardial infarction (MI). We compared outcomes among patients with and without POAF using multivariable adjusted Cox proportional hazards models. Among 18 117 patients (mean age 69 years, 57.4% male), 404 had POAF (2.2%). The stroke incidence 1 year after surgery was 5.58 vs. 1.54 per 100 patient-years in patients with and without POAF, adjusted hazard ratio (aHR) 3.43, 95% confidence interval (CI) 2.00-5.90; P 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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