Association of New-Onset Atrial Fibrillation After Noncardiac Surgery With Subsequent Stroke and Transient Ischemic Attack

Abstract

IMPORTANCE Outcomes of postoperative atrial fibrillation (AF) after noncardiac surgery are not well defined.OBJECTIVE To determine the association of new-onset postoperative AF vs no AF after noncardiac surgery with risk of nonfatal and fatal outcomes. DESIGN, SETTING, AND PARTICIPANTSRetrospective cohort study in Olmsted County, Minnesota, involving 550 patients who had their first-ever documented AF within 30 days after undergoing a noncardiac surgery (postoperative AF) between 2000 and 2013. Of these patients, 452 were matched 1:1 on age, sex, year of surgery, and type of surgery to patients with noncardiac surgery who were not diagnosed with AF within 30 days following the surgery (no AF). The last date of follow-up was December 31, 2018.EXPOSURES Postoperative AF vs no AF after noncardiac surgery. MAIN OUTCOMES AND MEASURESThe primary outcome was ischemic stroke or transient ischemic attack (TIA). Secondary outcomes included subsequent documented AF, all-cause mortality, and cardiovascular mortality.RESULTS Among 904 patients included in the matched analysis, the median age was 75 years (IQR, 67-82 years) and 51.8% of patients were men. Patients with postoperative AF had significantly higher CHA 2 DS 2 -VASc scores vs the no AF group (median, 4 [IQR, 2-5] vs 3 [IQR, 2-5]; P < .001). Over a median follow-up of 5.4 years (IQR, 1.4-9.2 years), there were 71 ischemic strokes or TIAs, 266 subsequent documented AF episodes, and 571 deaths, of which 172 were cardiovascular related. Patients with postoperative AF had a statistically significantly higher risk of ischemic stroke or TIA vs those with no AF. Patients with postoperative AF had statistically significantly higher risks of subsequent documented AF and all-cause death. No significant difference in the risk of cardiovascular death was observed for patients with and without postoperative AF.

Time for a paradigm shift in the follow‐up of colorectal cancer

“…Hence, we must find a system that allows us to identify patients with severe sequelae, offer treatment if needed and document the effect of our intervention. However, now, more than ever, our approach should be much broader; psychological problems need more attention [5,6], our patients die due to comorbidity [7] and even our younger patients (<60 years) face a substantially increased risk of sickness absence and early retirement up to 9 years after the treatment compared to the background population [8] (unpublished data).…”

Amiodarone with or without N-Acetylcysteine for the Prevention of Atrial Fibrillation after Thoracic Surgery: A Double-blind, Randomized Trial

“…In a retrospective study of a defined population of patients who underwent noncardiac surgery, development of subsequent atrial fibrillation was more common among patients who had postoperative atrial fibrillation than among patients who did not have postoperative atrial fibrillation. 4 Several observational studies using large databases have shown a clear link between postoperative atrial fibrillation after noncardiac surgery and subsequent *estimates for N-acetylcysteine versus placebo contrasts were extracted from logistic regression models for dichotomous outcomes (odds ratios, for outcomes with at least 10 events) and linear regression models for log-transformed length of stay outcome (coefficient, percentage increase in length of stay). As an adjustment for the interim analysis, 95.1% CI values are presented for the primary endpoint; all others are 95% CI.…”

“…• This double-blinded randomized trial of noncardiac thoracic surgery patients was done to test the hypothesis that the addition of N-acetylcysteine to concurrent amiodarone administration would reduce the incidence of postoperative atrial fibrillation when compared with placebo being concurrently administered with amiodarone • The study was halted midway for futility, as there was no difference in postoperative atrial fibrillation in the patients who received N-acetylcysteine plus amiodarone versus the patients who received placebo plus amiodarone T ransient atrial fibrillation after noncardiac thoracic or general surgery has long been thought to be a benign and self-limited disorder; however, new evidence suggests it may be a sentinel event that can be used to identify patients who are at risk of developing subsequent atrial fibrillation and who have a greater risk of short-and long-term stroke. [1][2][3][4] Postoperative atrial fibrillation may have hemodynamic consequences and result in treatment-related adverse events, such as bleeding, drug toxicity, and extended hospital stay of 2 to 4 days, with greater average cost of care of more than 30%. 1 As is the case for atrial fibrillation not related to surgery, age greater than 60 yr is strongly associated with postoperative atrial fibrillation.…”

“…Transient atrial fibrillation after noncardiac thoracic or general surgery has long been thought to be a benign and self-limited disorder; however, new evidence suggests it may be a sentinel event that can be used to identify patients who are at risk of developing subsequent atrial fibrillation and who have a greater risk of short- and long-term stroke. 1–4 Postoperative atrial fibrillation may have hemodynamic consequences and result in treatment-related adverse events, such as bleeding, drug toxicity, and extended hospital stay of 2 to 4 days, with greater average cost of care of more than 30%. 1 As is the case for atrial fibrillation not related to surgery, age greater than 60 yr is strongly associated with postoperative atrial fibrillation.…”

Risk Assessment of Hemodynamically Significant Arrhythmias after Elective Cardiac Operations with Cardiopulmonary Bypass Using the Modified Nomogram (Retrospective Study)

“…На данный момент существует множество работ, так или иначе затрагивающих тему впервые возникших послеоперационных нарушений ритма, как в кардиальной [1][2][3][4][5][6][7], так и в некардиальной хирургии [1,6,[8][9][10][11]. Известно, что фибрилляция предсердий наблюдается у 15-40% пациентов после аортокоронарного шунтирования, у 37-50% пациентов после операций на клапанах сердца и у 60% пациентов после сочетанных операций на клапанах и коронарных артериях [12][13][14].…”