Analysis: Postoperative AF just as dangerous as nonoperative AF
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The risk for stroke and other poor outcomes was similar in patients with postoperative atrial fibrillation after noncardiac surgery and in patients with AF not associated with surgery, researchers reported.
The researchers analyzed 4,231 patients from the Rochester Epidemiology Project who had incident AF from 2000 to 2013, of whom 13% had postoperative AF, defined as AF first being identified within 30 days of noncardiac surgery.
During a mean follow-up of 6.3 years, 486 patients had ischemic stroke or transient ischemic attack, 2,462 had subsequent AF and 2,565 died, Konstantinos C. Siontis, MD, cardiac electrophysiologist at Mayo Clinic in Rochester, Minnesota, and colleagues wrote.
At 5 years, the risk for stroke or TIA was not different between those who had postoperative AF and those who had nonoperative AF (absolute risk difference, 0.1%; 95% CI, –2.9 to 3.1; HR = 1.01; 95% CI, 0.77-1.32), according to the researchers.
There were also no differences between the groups at 5 years in risk for all-cause death (absolute risk difference, 2.4%; 95% CI, –0.3 to 5.1) or CV death (absolute risk difference, –1.1%; 95% CI, –4 to 1.8), they wrote.
However, patients with postoperative AF had lower risk for subsequent AF than patients with nonoperative AF at 5 years (absolute risk difference, –13.4%; 95% CI, –17.8 to –9; HR = 0.68; 95% CI, 0.6-0.77), the researchers found.
Of the patients who had postoperative AF in 2004, when anticoagulant prescription data became available, or later, 49.4% were prescribed oral anticoagulation compared with 61.7% of those with nonoperative AF. Of the patients with postoperative AF who had a CHA2DS2-VASc score of 2 or more, thus qualifying for oral anticoagulation, only 50.4% were prescribed it, Siontis and colleagues found.
“These findings further highlight that postoperative AF after noncardiac surgery should not be considered a transient, benign phenomenon,” the researchers wrote. “Rather, it is an arrhythmia that seems to portend similar thromboembolic risks as AF diagnosed outside of the operative setting.”
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