Major Adverse Cardiovascular Events Associated With Postoperative Atrial Fibrillation After Noncardiac Surgery: A Systematic Review and Meta-Analysis.

Autor:	AlTurki A; Division of Cardiology (A.A., V.E., T.H.), McGill University Health Center, Montreal, QC, Canada., Marafi M; Department of Neurology and Neurosurgery, Montreal Neurological Institute, QC, Canada (M.M., L.V.)., Proietti R; Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (R.P.)., Cardinale D; Cardioncology Unit, European Institute of Oncology, I.R.C.C.S, Milan, Italy (D.C.)., Blackwell R; Department of Urology, Loyola University Health Center, Chicago, IL (R.B.)., Dorian P; Division of Cardiology, St Michael's Hospital, University of Toronto, ON, Canada (P.D.)., Bessissow A; Division of General Internal Medicine (A.B.), McGill University Health Center, Montreal, QC, Canada., Vieira L; Department of Neurology and Neurosurgery, Montreal Neurological Institute, QC, Canada (M.M., L.V.)., Greiss I; Division of Cardiology, Univerity of Montreal Health Centre, QC, Canada (I.G.)., Essebag V; Division of Cardiology (A.A., V.E., T.H.), McGill University Health Center, Montreal, QC, Canada., Healey JS; Population Health Research Institute, McMaster University, Hamilton, ON, Canada (J.S.H.)., Huynh T; Division of Cardiology (A.A., V.E., T.H.), McGill University Health Center, Montreal, QC, Canada.
Jazyk:	angličtina
Zdroj:	Circulation. Arrhythmia and electrophysiology [Circ Arrhythm Electrophysiol] 2020 Jan; Vol. 13 (1), pp. e007437. Date of Electronic Publication: 2020 Jan 16.
DOI:	10.1161/CIRCEP.119.007437
Abstrakt:	Background: Postoperative atrial fibrillation (POAF) is a frequent occurrence after noncardiac surgery. It remains unclear whether POAF is associated with an increased risk of major adverse events. We aimed to elucidate the risk of stroke, myocardial infarction, and death associated with POAF following noncardiac surgery by a meta-analysis of randomized controlled studies and observational studies. Methods: We searched electronic databases from inception up to August 1, 2019 for all studies that reported stroke or myocardial infarction in adult patients who developed POAF following noncardiac surgery. We used random-effects models to summarize the studies. Results: The final analyses included 28 studies enrolling 2 612 816 patients. At 1-month (10 studies), POAF was associated with an ≈3-fold increase in the risk of stroke (weighted mean 2.1% versus 0.7%; odds ratio [OR], 2.82 [95% CI, 2.15-3.70]; P <0.001). POAF was associated with ≈4-fold increase in the long-term risk of stroke with (weighted mean, 2.0% versus 0.6%; OR, 4.12 [95% CI, 3.32-5.11]; P ≤0.001) in 8 studies with ≥12-month follow-up. There was a significant overall increase in the risk of stroke and myocardial infarction associated with POAF (weighted mean, 2.5% versus 0.9%; OR, 3.44 [95% CI, 2.38-4.98]; P <0.001) and (weighted mean, 12.6% versus 2.7%; OR, 4.02 [95% CI, 3.08-5.24]; P <0.001), respectively. Furthermore, POAF was associated with a 3-fold increase in all-cause mortality at 30 days (weighted mean, 15.0% versus 5.4%; OR, 3.36 [95% CI, 2.13-5.31]; P <0.001). Conclusions: POAF was associated with markedly higher risk of stroke, myocardial infarction, and all-cause mortality following noncardiac surgery. Future studies are needed to evaluate the impact of optimal cardiovascular pharmacotherapies to prevent POAF and to decrease the risk of major adverse events in these high-risk patients.
Databáze:	MEDLINE
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