Key result
Preoperative atrial fibrillation was associated with a significantly higher risk of major adverse cardiac and cerebrovascular events within 30 days after non-cardiac surgery (OR 2.97).
Why the study?
The clinical implications of atrial fibrillation with respect to peri-operative cardiovascular outcomes in patients undergoing non-cardiac surgery remain unclear.
Does preoperative nonvalvular atrial fibrillation increase the risk of major adverse cardiac and cerebrovascular events in patients undergoing non-cardiac surgery?
Cohort (n=26,501)
No
Does preoperative nonvalvular atrial fibrillation increase the risk of major adverse cardiac and cerebrovascular events in patients undergoing non-cardiac surgery?
Odds Ratio: 2.97 (95% CI 2.13–4.07)
Absolute Event Rate: 4.6% vs 1.2%
p-value: p=<0.001
Preoperative nonvalvular atrial fibrillation is an independent predictor of 30-day major adverse cardiac and cerebrovascular events in patients undergoing non-cardiac surgery, and improves the discriminating performance of the revised cardiac risk index.
Preoperative AF may warrant closer monitoring in non-cardiac surgery; leaves open whether it enhances revised cardiac risk index performance.
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.
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Cho et al. (2019) conducted a cohort in Patients undergoing non-cardiac surgery (n=26,501). Preoperative nonvalvular atrial fibrillation vs. Patients without atrial fibrillation was evaluated on Rate of major adverse cardiac and cerebrovascular events (MACCE) during immediate post-surgery period (<30 days) (OR 2.97, 95% CI 2.13-4.07, p=<0.001). Preoperative atrial fibrillation was associated with a significantly higher risk of major adverse cardiac and cerebrovascular events within 30 days after non-cardiac surgery (OR 2.97).
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