What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Patients undergoing cardiac surgery (n=132208). Intervention: Atrial fibrillation vs. No atrial fibrillation at baseline. Primary outcome: Incidence of stroke (OR 2, 95% CI 1.7-2.1, p=<0.0001).

March 29, 2025Open Access

Incidence of stroke in patients with atrial fibrillation undergoing surgical treatment: a meta-analysis

Q: What are the key findings of this study?

Pre-existing atrial fibrillation in patients undergoing general cardiac surgery was associated with a significantly higher risk of postoperative stroke compared to those without atrial fibrillation (OR 2).

Key Result

Pre-existing atrial fibrillation in patients undergoing general cardiac surgery was associated with a significantly higher risk of postoperative stroke compared to those without atrial fibrillation (OR 2).

Study Design

Type

Meta-Analysis (n=132,208)

Structured PICO

Does pre-existing atrial fibrillation increase the risk of stroke in patients undergoing cardiac surgery?

Population

132,208 patients aged 18 years and older undergoing cardiovascular surgical treatments, followed for a median of over 1.5 years to assess the risk of stroke associated with atrial fibrillation.

Exposure

Presence of atrial fibrillation (AF) in patients undergoing cardiac surgical interventions (including CABG, valve surgeries, PCI, TAVR, LAAC, LAAO, and general cardiac surgery).

Comparator

Patients without atrial fibrillation at baseline undergoing the same surgical procedures.

Outcome

Cerebrovascular events, including ischemic and haemorrhagic strokes, all-cause mortality, myocardial infarction, and a composite of haemorrhaging strokes.hard clinical

Pre-existing atrial fibrillation is associated with a significantly increased risk of stroke in patients undergoing cardiac surgical interventions.

Main Result

Odds Ratio: 2 (95% CI 1.7–2.1)

p-value: p=<0.0001

Limitations

Heterogeneity in the populations
Variations in surgery
No detailed description of stroke subtypes
Lack of individual patient data
Bias in publications reported
Many included studies poorly defined stroke outcomes

Abstract

INTRODUCTION: Atrial fibrillation (AF) is self-limiting condition, but it may also increase the risk of stroke and death. The association between AF and surgery with stroke was assessed both subjectively and statistically using systematic review and meta-analysis. METHODS: For data collection, a thorough search was made in PubMed, EMBASE, Science Direct, Google Scholar, and Cochrane Library using searching keywords "postoperative ischemic stroke, atrial fibrillation, stroke, cardiac surgery, brain ischemia, and heart surgery". Direct and indirect comparisons were made using random-effect network meta-analysis. RESULTS: 16-studies were identified comprising of 132,208 patient, 64% male, median age > 63 years and follow-up > 1.5 years. Pooling the results from the random-effects model showed odds ratios associated with the risk of stroke of surgical processes (CABG) in patients with AF. The odds ratio OR = 1.1 (0.65-1.54, P 0.001), study-6 OR 1.8 (1.7-1.9, P > 0.001), and study-14 OR 7.8 (6.2-8.1, P > 0.0001). CONCLUSION: The study clearly defines stroke outcomes when they are quantified, however, further research is required.

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