Risk of stroke and other adverse outcomes in patients with perioperative atrial fibrillation 1 year after non-cardiac...

Area of Science:

• Cardiology
• Perioperative Medicine
• Neurology

Background:

• Perioperative atrial fibrillation (POAF) is a common complication after non-cardiac surgery.
• The long-term consequences of POAF on cardiovascular outcomes remain a significant concern for patient management.
• Existing research has not fully elucidated the 1-year risk profile associated with new-onset POAF.

Purpose of the Study:

• To determine the 1-year incidence of stroke in patients newly diagnosed with perioperative atrial fibrillation (POAF) following non-cardiac surgery.
• To assess the associated risks of mortality and myocardial infarction (MI) at 1 year in patients with POAF.
• To compare adverse outcomes between patients with and without POAF after non-cardiac procedures.

Main Methods:

• Combined data from the PeriOperative ISchemic Evaluation (POISE)-1 and POISE-2 trials, excluding patients with pre-existing atrial fibrillation.
• Defined perioperative atrial fibrillation as new-onset AF within 30 days post-surgery.
• Utilized multivariable adjusted Cox proportional hazards models to analyze the primary outcome (stroke) and secondary outcomes (mortality, MI) at 1-year follow-up.

Main Results:

• Among 18,117 patients, 404 (2.2%) developed POAF.
• Patients with POAF exhibited a significantly higher 1-year stroke incidence (5.58 vs. 1.54 per 100 patient-years; aHR 3.43).
• POAF was associated with increased risks of death (aHR 2.51) and MI (aHR 5.10) at 1 year.

Conclusions:

• New-onset perioperative atrial fibrillation substantially increases the 1-year risk of stroke, myocardial infarction, and mortality.
• This study highlights POAF as a critical indicator of increased perioperative risk.
• Further interventional studies are warranted to develop and test risk reduction strategies for patients with POAF.