Department of Intensive Care and Perioperative Medicine (Szczeklik, Fronczek, Polok, Górka), Jagiellonian University Medical College, Kraków, Poland; Population Health Research Institute (LeManach, Conen, Duceppe, Pettit, Devereaux) and Department of Health Research Methods, Evidence, and Impact (LeManach, Conen, Heels-Ansdell), McMaster University, Hamilton, Ont.; Division of General Internal Medicine, Department of Medicine (McAlister), University of Alberta, Edmonton, Alta.; Department of Surgery (Srinathan), University of Manitoba, Winnipeg, Man.; Iberoamerican Cochrane Center (Alonso-Coello), Biomedical Research Institute Sant Pau (IIB-Sant Pau-CIBERESP), Barcelona, Spain; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital and University of Cape Town, South Africa; Division of Nephrology (Roshanov), Department of Medicine, London Health Sciences Centre, London, Ont.
CMAJ. 2020 Dec 7;192(49):E1715-E1722. doi: 10.1503/cmaj.200840.
Postoperative atrial fibrillation (POAF) is associated with clinically significant short- and long-term complications after noncardiac surgery. Our aim was to describe the incidence of clinically important POAF after noncardiac surgery and establish the prognostic value of N-terminal pro-brain-type natriuretic peptide (NT-proBNP) in this context.
The Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION) Study was a prospective cohort study involving patients aged 45 years and older who had inpatient noncardiac surgery that was performed between August 2007 and November 2013. We determined 30-day incidence of clinically important POAF (i.e., resulting in angina, congestive heart failure, symptomatic hypotension or requiring treatment) using logistic regression models to analyze the association between preoperative NT-proBNP and POAF.
In 37 664 patients with no history of atrial fibrillation, we found that the incidence of POAF was 1.0% (95% confidence interval [CI] 0.9%-1.1%; 369 events); 3.2% (95% CI 2.3%-4.4%) in patients undergoing major thoracic surgery, 1.3% (95% CI 1.2%-1.5%) in patients undergoing major nonthoracic surgery and 0.2% (95% CI 0.1%-0.3%) in patients undergoing low-risk surgery. In a subgroup of 9789 patients with preoperative NT-proBNP measurements, the biomarker improved the prediction of POAF risk over conventional prognostic factors (likelihood ratio test < 0.001; fraction of new information from NT-proBNP was 16%). Compared with a reference NT-proBNP measurement set at 100 ng/L, adjusted odds ratios for the occurrence of POAF were 1.31 (95% CI 1.15-1.49) at 200 ng/L, 2.07 (95% CI 1.27-3.36) at 1500 ng/L and 2.39 (95% CI 1.26-4.51) at 3000 ng/L.
We determined that the incidence of clinically important POAF after noncardiac surgery was 1.0%. We also found that preoperative NT-proBNP levels were associated with POAF independent of established prognostic factors. ClinicalTrials.gov, no. NCT00512109.
非心脏手术后心房颤动（POAF）与短期和长期的临床相关并发症有关。我们的目的是描述非心脏手术后临床显著的 POAF 的发生率，并确定 N 末端脑利钠肽前体（NT-proBNP）在此背景下的预后价值。
血管事件非心脏手术患者队列评估（VISION）研究是一项前瞻性队列研究，纳入了 2007 年 8 月至 2013 年 11 月期间接受住院非心脏手术的年龄在 45 岁及以上的患者。我们使用逻辑回归模型来确定 30 天内临床重要 POAF（即导致心绞痛、充血性心力衰竭、症状性低血压或需要治疗）的发生率，以分析术前 NT-proBNP 与 POAF 之间的关联。
在 37664 例无房颤病史的患者中，我们发现 POAF 的发生率为 1.0%（95%置信区间 [CI]0.9%-1.1%；369 例事件）；大胸手术患者为 3.2%（95% CI 2.3%-4.4%），大非胸手术患者为 1.3%（95% CI 1.2%-1.5%），低风险手术患者为 0.2%（95% CI 0.1%-0.3%）。在术前 NT-proBNP 测量的 9789 例患者亚组中，该生物标志物改善了 POAF 风险的预测，优于传统的预后因素（似然比检验<0.001；NT-proBNP 带来的新信息比例为 16%）。与参考 NT-proBNP 测量值为 100ng/L 相比，POAF 发生的校正比值比为 1.31（95% CI 1.15-1.49）时为 200ng/L，1.27-3.36 时为 1500ng/L，1.26-4.51 时为 3000ng/L。
我们确定非心脏手术后临床显著 POAF 的发生率为 1.0%。我们还发现，术前 NT-proBNP 水平与 POAF 相关，独立于既定的预后因素。ClinicalTrials.gov，编号 NCT00512109。
