AF onset after noncardiac surgery confers elevated stroke, MI, mortality
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In a meta-analysis of randomized controlled trials and observational studies, atrial fibrillation after noncardiac surgery was associated with significant increases in risk for stroke, MI and all-cause mortality, according to research published in Circulation: Arrhythmia and Electrophysiology.
From 10 studies, researchers determined that, at 1 month, postoperative AF was associated with an approximately threefold increase in risk for stroke (weighted mean, 2.1% vs. 0.7%; OR = 2.82; 95% CI, 2.15-3.7). Additionally, from eight studies with at least 12 months of follow-up, postoperative AF was associated with an approximately fourfold increase in long-term risk for stroke (weighted mean, 2% vs. 0.6%; OR = 4.12; 95% CI, 3.32-5.11).
Moreover, researchers noted a significant increase in overall risk for stroke (weighted mean, 2.5% vs. 0.9%; OR = 3.44; 95% CI, 2.38-4.98) and MI (weighted mean, 12.6% vs. 2.7%; OR = 4.02; 95% CI, 3.08-5.24) associated with postoperative AF.
Heterogeneity between studies was not significant (I2 = 34.6%).
“The findings of this meta-analysis should provide the impetus for large, prospective studies of predefined postoperative AF with adjudicated outcomes to understand the causal relationship between postoperative AF and stroke,” Ahmed AlTurki, MD, of the division of cardiology at McGill University Health Center, Montreal, and colleagues wrote. “The advent of monitoring devices, either patient-initiated or implantable, would allow correlation of the persistence of postoperative AF and its temporal relationship to cardiovascular outcomes.”
In other findings, postoperative AF after noncardiac surgery was also associated with an approximately threefold increase in all-cause mortality at 30 days (weighted mean, 15% vs. 5.4%; OR = 3.36; 95% CI, 2.13-5.31).
The full meta-analysis included 2,612,816 patients enrolled in 28 studies worldwide. Investigators included studies published between 2000 and 2019 that reported stroke or MI in adult patients who developed postoperative AF after undergoing noncardiac surgery and used random-effects models to summarize the results.
“The increased mortality risk in this meta-analysis was observed across a variety of surgical procedures and geographic locations,” the researchers wrote. “Stroke due to postoperative AF may have contributed to mortality or postoperative AF may just be a marker of an older population with multiple comorbidities at higher risk of major cardiovascular events. Overall, considering the significantly higher potentially life-threatening complications associated with postoperative AF following noncardiac surgery, further efforts should be invested in examining whether the prevention and detection of postoperative AF improves outcomes.” – by Scott Buzby
Disclosures: The authors report no relevant financial disclosures.
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