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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Preoperative Atrial Fibrillation and Cardiovascular Outcomes After Noncardiac Surgery

Sameer Prasada1, Milind Y Desai1, Marwan Saad2

  • 1Heart, Thoracic and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.

Journal of the American College of Cardiology
|June 23, 2022
PubMed

Insights

Pre-existing atrial fibrillation (AF) increases the risk of mortality, heart failure, and stroke after noncardiac surgery. AF also improves the prediction of these adverse events when combined with standard risk scores.

Area of Science:

  • Cardiology
  • Perioperative Medicine
  • Public Health

Background:

  • The impact of pre-existing atrial fibrillation (AF) on outcomes following noncardiac surgery (NCS) remains unclear.
  • Understanding this association is crucial for optimizing patient care and risk stratification.

Purpose of the Study:

  • To investigate the association between pre-existing AF and adverse outcomes after NCS.
  • To evaluate the incremental predictive value of AF in addition to established risk indices.

Main Methods:

  • A nationwide cohort of Medicare beneficiaries undergoing NCS from 2015-2019 was analyzed.
  • Patients were categorized into groups with and without AF, and propensity score matching was employed to control for confounding factors.
  • Key outcomes included 30-day mortality, stroke, myocardial infarction, and heart failure.

Main Results:

  • In a cohort of over 8.6 million patients, 16.4% had pre-existing AF.
  • After matching, AF was linked to significantly higher risks of mortality (OR 1.31), heart failure (OR 1.31), and stroke (OR 1.40), but a lower risk of myocardial infarction (OR 0.81).
  • AF demonstrated improved discriminative ability when added to the Revised Cardiac Risk Index (RCRI), increasing the C-statistic from 0.73 to 0.76.

Conclusions:

  • Pre-existing AF is an independent predictor of adverse postoperative outcomes after noncardiac surgery.
  • Incorporating AF status into risk assessment models can enhance the prediction of surgical complications.
Abstract

Keywords:
atrial fibrillationcardiovascular outcomesmortalitynoncardiac surgery

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