TY - JOUR
T1 - Associations of Atrial Fibrillation After Noncardiac Surgery With Stroke, Subsequent Arrhythmia, and Death A Cohort Study
AU - Siontis, Konstantinos C.
AU - Gersh, Bernard J.
AU - Weston, Susan A.
AU - Jiang, Ruoxiang
AU - Roger, Véronique L.
AU - Noseworthy, Peter A.
AU - Chamberlain, Alanna M.
N1 - Funding Information:
Financial Support: This work was supported by the National Institute on Aging (R21 AG062580) and was made possible using the resources of the REP, which is supported by the National Institute on Aging (R01 AG058738), the Mayo Clinic Research Committee, and fees paid annually by REP users.
Publisher Copyright:
© 2022 American College of Physicians.
PY - 2022/8/1
Y1 - 2022/8/1
N2 - Background: Postoperative atrial fibrillation (AF) after noncardiac surgery confers increased risks for ischemic stroke and transient ischemic attack (TIA). How outcomes for postoperative AF after noncardiac surgery compare with those for AF occurring outside of the operative setting is unknown. Objective: To compare the risks for ischemic stroke or TIA and other outcomes in patients with postoperative AF versus those with incident AF not associated with surgery. Design: Cohort study. Setting: Olmsted County, Minnesota. Participants: Patients with incident AF between 2000 and 2013. Measurements: Patients were categorized as having AF occurring within 30 days of a noncardiac surgery (postoperative AF) or having AF unrelated to surgery (nonoperative AF). Results: Of 4231 patients with incident AF, 550 (13%) had postoperative AF as their first-ever documented AF presentation. Over a mean follow-up of 6.3 years, 486 patients had an ischemic stroke or TIA and 2462 had subsequent AF; a total of 2565 deaths occurred. The risk for stroke or TIA was similar between those with postoperative AF and nonoperative AF (absolute risk difference [ARD] at 5 years, 0.1% [95% CI, -2.9% to 3.1%]; hazard ratio [HR], 1.01 [CI, 0.77 to 1.32]). A lower risk for subsequent AF was seen for patients with postoperative AF (ARD at 5 years, -13.4% [CI, -17.8% to -9.0%]; HR, 0.68 [CI, 0.60 to 0.77]). Finally, no difference was seen for cardiovascular death or all-cause death between patients with postoperative AF and nonoperative AF. Limitation: The population consisted predominantly of White patients; caution should be used when extrapolating the results to more racially diverse populations. Conclusion: Postoperative AF after noncardiac surgery is associated with similar risk for thromboembolism compared with nonoperative AF. Our findings have potentially important implications for the early postsurgical and subsequent management of postoperative AF.
AB - Background: Postoperative atrial fibrillation (AF) after noncardiac surgery confers increased risks for ischemic stroke and transient ischemic attack (TIA). How outcomes for postoperative AF after noncardiac surgery compare with those for AF occurring outside of the operative setting is unknown. Objective: To compare the risks for ischemic stroke or TIA and other outcomes in patients with postoperative AF versus those with incident AF not associated with surgery. Design: Cohort study. Setting: Olmsted County, Minnesota. Participants: Patients with incident AF between 2000 and 2013. Measurements: Patients were categorized as having AF occurring within 30 days of a noncardiac surgery (postoperative AF) or having AF unrelated to surgery (nonoperative AF). Results: Of 4231 patients with incident AF, 550 (13%) had postoperative AF as their first-ever documented AF presentation. Over a mean follow-up of 6.3 years, 486 patients had an ischemic stroke or TIA and 2462 had subsequent AF; a total of 2565 deaths occurred. The risk for stroke or TIA was similar between those with postoperative AF and nonoperative AF (absolute risk difference [ARD] at 5 years, 0.1% [95% CI, -2.9% to 3.1%]; hazard ratio [HR], 1.01 [CI, 0.77 to 1.32]). A lower risk for subsequent AF was seen for patients with postoperative AF (ARD at 5 years, -13.4% [CI, -17.8% to -9.0%]; HR, 0.68 [CI, 0.60 to 0.77]). Finally, no difference was seen for cardiovascular death or all-cause death between patients with postoperative AF and nonoperative AF. Limitation: The population consisted predominantly of White patients; caution should be used when extrapolating the results to more racially diverse populations. Conclusion: Postoperative AF after noncardiac surgery is associated with similar risk for thromboembolism compared with nonoperative AF. Our findings have potentially important implications for the early postsurgical and subsequent management of postoperative AF.
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U2 - 10.7326/M22-0434
DO - 10.7326/M22-0434
M3 - Article
C2 - 35878404
AN - SCOPUS:85136016280
SN - 0003-4819
VL - 175
SP - 1065
EP - 1072
JO - Annals of internal medicine
JF - Annals of internal medicine
IS - 8
ER -