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. 2020 Feb;50(2):148-159.
doi: 10.4070/kcj.2019.0219. Epub 2019 Nov 19.

Clinical Implications of Preoperative Nonvalvular Atrial Fibrillation with Respect to Postoperative Cardiovascular Outcomes in Patients Undergoing Non-Cardiac Surgery

Min Soo Cho #  1 , Cheol Hyun Lee #  2 , Jun Kim  3 , Jung Min Ahn  1 , Minkyu Han  4 , Gi Byoung Nam  1 , Kee Joon Choi  1 , You Ho Kim  1
Affiliations

Clinical Implications of Preoperative Nonvalvular Atrial Fibrillation with Respect to Postoperative Cardiovascular Outcomes in Patients Undergoing Non-Cardiac Surgery

Min Soo Cho et al. Korean Circ J. 2020 Feb.

Abstract

Background and objectives: Atrial fibrillation (AF) is associated with a higher long-term risk of major cardiovascular events. However, its clinical implications with respect to peri-operative cardiovascular outcomes in patients undergoing non-cardiac surgery is unclear. We tried to examine the association between pre-operative AF and peri-operative cardiovascular outcomes.

Methods: We retrospectively analyzed data from 26,501 consecutive patients who underwent comprehensive preoperative cardiac evaluations for risk stratification prior to receiving non-cardiac surgery at our center. Preoperative AF was diagnosed in 1,098 patients (4.1%), and their cardiovascular outcomes were compared with those of patients without AF. The primary outcome was the rate of major adverse cardiac and cerebrovascular events (MACCE) during immediate post-surgery period (<30 days).

Results: Patients with AF were older and had higher proportion of male sex, higher rate of extra-cardiac comorbidities, higher CHA₂DS2-VASc score, and higher revised cardiac risk index (RCRI) compared with those without AF. The rate of MACCE was significantly higher in AF patients compared to non-AF patients (4.6% vs. 1.2%, p<0.001). Preoperative AF was associated with higher risk of MACCE, even after multivariable adjustment (odds ratio, 2.97; 95% confidence interval, 2.13-4.07, p<0.001). The relative contribution of AF to MACCE was larger in patients with lower RCRI (p for interaction=0.010). The discriminating performance of RCRI was significantly enhanced by addition of AF.

Conclusions: In patients undergoing non-cardiac surgery, preoperative AF was associated with a higher risk of peri-operative cardiovascular outcomes.

Keywords: Atrial fibrillation; Risk assessment; Stroke; Surgery.

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Figure 1
Figure 1. Study flow-diagram.
AF = atrial fibrillation.
Figure 2
Figure 2. Rate of MACCE (A) and ischemic strokes (B) during the immediate postoperative period.
AF = atrial fibrillation; MACCE = major adverse cardiac and cerebrovascular events.
Figure 3
Figure 3. Rate of MACCE by the AF status, stratified by the revised cardiac risk.
AF = atrial fibrillation; CI = confidence interval; MACCE = major adverse cardiac and cerebrovascular events; OR = odds ratio.
Figure 4
Figure 4. Rate of ischemic strokes by the AF status stratified by the CHA2DS2-VASc score.
AF = atrial fibrillation.
See this image and copyright information in PMC

References

    1. Stewart S, Hart CL, Hole DJ, McMurray JJ. A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study. Am J Med. 2002;113:359–364. - PubMed
    1. Priebe HJ. Triggers of perioperative myocardial ischaemia and infarction. Br J Anaesth. 2004;93:9–20. - PubMed
    1. Grau AJ, Eicke M, Burmeister C, Hardt R, Schmitt E, Dienlin S. Risk of ischemic stroke and transient ischemic attack is increased up to 90 days after non-carotid and non-cardiac surgery. Cerebrovasc Dis. 2017;43:242–249. - PubMed
    1. Smilowitz NR, Gupta N, Ramakrishna H, Guo Y, Berger JS, Bangalore S. Perioperative major adverse cardiovascular and cerebrovascular events associated with noncardiac surgery. JAMA Cardiol. 2017;2:181–187. - PMC - PubMed
    1. Longstreth WT, Jr, Bernick C, Fitzpatrick A, et al. Frequency and predictors of stroke death in 5,888 participants in the Cardiovascular Health Study. Neurology. 2001;56:368–375. - PubMed