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What is the prognostic significance of new-onset atrial fibrillation (AF) after noncardiac surgery?
This retrospective cohort study included 904 participants who underwent noncardiac surgery. Comparing those with vs without postoperative AF, the hazard ratio for ischemic stroke or transient ischemic attack was 2.69, which was statistically significant.
New-onset AF after noncardiac surgery was significantly associated with increased risk of subsequent stroke or transient ischemic attack.
Outcomes of postoperative atrial fibrillation (AF) after noncardiac surgery are not well defined.
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 Participants
Retrospective 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.
Postoperative AF vs no AF after noncardiac surgery.
Main Outcomes and Measures
The primary outcome was ischemic stroke or transient ischemic attack (TIA). Secondary outcomes included subsequent documented AF, all-cause mortality, and cardiovascular mortality.
The median age of the 452 matched patients was 75 years (IQR, 67-82 years) and 51.8% of patients were men. Patients with postoperative AF had significantly higher CHA2DS2-VASc scores than those in 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 exhibited a statistically significantly higher risk of ischemic stroke or TIA (incidence rate, 18.9 vs 10.0 per 1000 person-years; absolute risk difference [RD] at 5 years, 4.7%; 95% CI, 1.0%-8.4%; HR, 2.69; 95% CI, 1.35-5.37) compared with those with no AF. Patients with postoperative AF had statistically significantly higher risks of subsequent documented AF (incidence rate 136.4 vs 21.6 per 1000 person-years; absolute RD at 5 years, 39.3%; 95% CI, 33.6%-45.0%; HR, 7.94; 95% CI, 4.85-12.98), and all-cause death (incidence rate, 133.2 vs 86.8 per 1000 person-years; absolute RD at 5 years, 9.4%; 95% CI, 4.9%-13.7%; HR, 1.66; 95% CI, 1.32-2.09). No significant difference in the risk of cardiovascular death was observed for patients with and without postoperative AF (incidence rate, 42.5 vs 25.0 per 1000 person-years; absolute RD at 5 years, 6.2%; 95% CI, 2.2%-10.4%; HR, 1.51; 95% CI, 0.97-2.34).
Conclusions and Relevance
Among patients undergoing noncardiac surgery, new-onset postoperative AF compared with no AF was associated with a significant increased risk of stroke or TIA. However, the implications of these findings for the management of postoperative AF, such as the need for anticoagulation therapy, require investigation in randomized trials.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Alanna M. Chamberlain, PhD, Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (firstname.lastname@example.org).
Accepted for Publication: June 26, 2020.
Author Contributions: Dr Chamberlain had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Siontis, Gersh, Kashou, Roger, Noseworthy, Chamberlain.
Acquisition, analysis, or interpretation of data: Siontis, Weston, Jiang, Chamberlain.
Drafting of the manuscript: Siontis, Kashou, Chamberlain.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Weston, Jiang.
Administrative, technical, or material support: Chamberlain.
Supervision: Noseworthy, Chamberlain.
Conflict of Interest Disclosures: Dr Chamberlain reported receiving grants from National Institute on Aging. No other disclosures were reported.
Funding/Support: This work was supported by grant R21 AG062580 from the National Institute on Aging and was made possible using the resources from the Rochester Epidemiology Project through grant R01 AG034676 from the National Institute on Aging.
Role of the Funder/Sponsor: The National Institute on Aging had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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