Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota (K.C.S., B.J.G.).
Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota (S.A.W., R.J.).
Ann Intern Med. 2022 Aug;175(8):1065-1072. doi: 10.7326/M22-0434. Epub 2022 Jul 26.
Postoperative atrial fibrillation (AF) after noncardiac surgery confers increased risks for ischemic stroke and transient ischemic attack (TIA). How outcomes for postoperative AF after noncardiac surgery compare with those for AF occurring outside of the operative setting is unknown.
To compare the risks for ischemic stroke or TIA and other outcomes in patients with postoperative AF versus those with incident AF not associated with surgery.
Cohort study.
Olmsted County, Minnesota.
Patients with incident AF between 2000 and 2013.
Patients were categorized as having AF occurring within 30 days of a noncardiac surgery (postoperative AF) or having AF unrelated to surgery (nonoperative AF).
Of 4231 patients with incident AF, 550 (13%) had postoperative AF as their first-ever documented AF presentation. Over a mean follow-up of 6.3 years, 486 patients had an ischemic stroke or TIA and 2462 had subsequent AF; a total of 2565 deaths occurred. The risk for stroke or TIA was similar between those with postoperative AF and nonoperative AF (absolute risk difference [ARD] at 5 years, 0.1% [95% CI, -2.9% to 3.1%]; hazard ratio [HR], 1.01 [CI, 0.77 to 1.32]). A lower risk for subsequent AF was seen for patients with postoperative AF (ARD at 5 years, -13.4% [CI, -17.8% to -9.0%]; HR, 0.68 [CI, 0.60 to 0.77]). Finally, no difference was seen for cardiovascular death or all-cause death between patients with postoperative AF and nonoperative AF.
The population consisted predominantly of White patients; caution should be used when extrapolating the results to more racially diverse populations.
Postoperative AF after noncardiac surgery is associated with similar risk for thromboembolism compared with nonoperative AF. Our findings have potentially important implications for the early postsurgical and subsequent management of postoperative AF.
National Institute on Aging.
非心脏手术后的心房颤动（AF）会增加缺血性卒中和短暂性脑缺血发作（TIA）的风险。非心脏手术后发生的术后 AF 与手术以外发生的 AF 的结果相比如何尚不清楚。
比较术后 AF 与非手术相关的非手术性 AF 患者发生缺血性卒中和 TIA 及其他结局的风险。
队列研究。
明尼苏达州奥姆斯特德县。
2000 年至 2013 年间发生过 AF 的患者。
将患者分为非心脏手术后 30 天内发生 AF（术后 AF）或与手术无关的 AF（非手术性 AF）。
在 4231 例有记录的 AF 患者中，550 例（13%）首次记录的 AF 为术后 AF。在平均 6.3 年的随访中，486 例发生缺血性卒中和 TIA，2462 例发生后续 AF；共有 2565 例死亡。术后 AF 患者和非手术性 AF 患者的卒中或 TIA 风险相似（5 年时的绝对风险差异，0.1%[95%CI，-2.9%至 3.1%]；风险比[HR]，1.01[CI，0.77 至 1.32]）。术后 AF 患者发生后续 AF 的风险较低（5 年时的绝对风险差异，-13.4%[CI，-17.8%至-9.0%]；HR，0.68[CI，0.60 至 0.77]）。最后，术后 AF 患者与非手术性 AF 患者在心血管死亡或全因死亡方面无差异。
该人群主要由白人患者组成；在将结果推断到种族多样化的人群时应谨慎。
非心脏手术后的 AF 与非手术性 AF 相比，血栓栓塞的风险相似。我们的研究结果对术后 AF 的早期术后和后续管理具有重要意义。
美国国立卫生研究院老龄化研究所。
