David Conen1,2,3, Pablo Alonso-Coello3,4, James Douketis2, Matthew T V Chan5, Andrea Kurz6, Alben Sigamani7, Joel L Parlow8, Chew Yin Wang9, Juan C Villar10, Sadeesh K Srinathan11, Maria Tiboni2, German Malaga12, Gordon Guyatt2,3, Soori Sivakumaran13, Maria-Virginia Rodriguez Funes14, Patricia Cruz15, Homer Yang16, George K Dresser17, Jesus Alvarez-Garcia18, Thomas Schricker19, Philip M Jones16,20, Leanne W Drummond21, Kumar Balasubramanian1, Salim Yusuf1,2,3, P J Devereaux1,2,3. 1. Population Health Research Institute, McMaster University, Hamilton, Canada. 2. Department of Medicine, McMaster University, 1280 Main St W, Hamilton L8S 4K1, Canada. 3. Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton L8S 4K1, Canada. 4. Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau-CIBERESP), Sant Antoni Maria Claret 167, 08025 Barcelona, Spain. 5. Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong Special administrative Region, China. 6. Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44120, USA. 7. Department of Clinical Research, Narayana Hrudayalaya Limited, 258/A, Hosur Road, Bommasandra Industrial Area, Anekal Taluk, Bangalore 560099, India. 8. Department of Anesthesiology and Perioperative Medicine, Kingston Health Sciences Centre and Queen's University, 76 Stuart St, Kingston, ON K7L 2V7, Canada. 9. Department of Anesthesiology, University of Malaya, 50603 Kuala Lumpur, Malaysia. 10. Departamento de Investigaciones, Fundación Cardioinfantil -Instituto de Cardiología and Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Av. 42 ##48 - 11, Bucaramanga, Santander, Colombia. 11. Department of Surgery, University of Manitoba, Rm. GE61, 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada. 12. School of Medicine, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martín de Porres 15102, Lima, Peru. 13. Department of Medicine, University of Alberta, 116 St & 85 Ave, Edmonton, AB T6G 2R3, Canada. 14. Unidad de Investigacion Cientifica, Facultad de Medicina, Universidad de El Salvador, Final 25 Ave norte, San Salvador, El Salvador. 15. Department of Anesthesia, Hospital General Universitario Gregorio Marañon, Calle del Dr. Esquerdo 46, 28007 Madrid, Spain. 16. Department of Anesthesia & Perioperative Medicine, University of Western Ontario, 1151 Richmond St, London, ON N6A 3K7, Canada. 17. Department of Medicine, London Health Sciences Centre, Victoria Hospital, 800 Commissioners Rd E, London, ON N6A 5W9, Canada. 18. Department of Cardiology, Hospital de la Santa Creu i Sant Pau, CIBERCV, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autonoma de Barcelona, Carrer de Sant Quintí, 89, 08041 Barcelona, Spain. 19. Department of Anesthesia, McGill University Health Centre, McGill University, 1001 Decarie Blvd, Montreal, QC H4A 3J1, Canada. 20. Department of Epidemiology & Biostatistics, University of Western Ontario, 1151 Richmond St, London, ON N6A 3K7, Canada. 21. Department of Anaesthesia, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, 719 Umbilo Road, Umbilo, 4001, South Africa.
Abstract
AIMS: To determine the 1-year risk of stroke and other adverse outcomes in patients with a new diagnosis of perioperative atrial fibrillation (POAF) after non-cardiac surgery. METHODS AND RESULTS: The PeriOperative ISchemic Evaluation (POISE)-1 trial evaluated the effects of metoprolol vs. placebo in 8351 patients, and POISE-2 compared the effect of aspirin vs. placebo, and clonidine vs. placebo in 10 010 patients. These trials included patients with, or at risk of, cardiovascular disease who were undergoing non-cardiac surgery. For the purpose of this study, we combined the POISE datasets, excluding 244 patients who were in atrial fibrillation (AF) at the time of randomization. Perioperative atrial fibrillation was defined as new AF that occurred within 30 days after surgery. Our primary outcome was the incidence of stroke at 1 year of follow-up; secondary outcomes were mortality and myocardial infarction (MI). We compared outcomes among patients with and without POAF using multivariable adjusted Cox proportional hazards models. Among 18 117 patients (mean age 69 years, 57.4% male), 404 had POAF (2.2%). The stroke incidence 1 year after surgery was 5.58 vs. 1.54 per 100 patient-years in patients with and without POAF, adjusted hazard ratio (aHR) 3.43, 95% confidence interval (CI) 2.00-5.90; P < 0.001. Patients with POAF also had an increased risk of death (incidence 31.37 vs. 9.34; aHR 2.51, 95% CI 2.01-3.14; P < 0.001) and MI (incidence 26.20 vs. 8.23; aHR 5.10, 95% CI 3.91-6.64; P < 0.001). CONCLUSION: Patients with POAF have a significantly increased risk of stroke, MI, and death at 1 year. Intervention studies are needed to evaluate risk reduction strategies in this high-risk population. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: To determine the 1-year risk of stroke and other adverse outcomes in patients with a new diagnosis of perioperative atrial fibrillation (POAF) after non-cardiac surgery. METHODS AND RESULTS: The PeriOperative ISchemic Evaluation (POISE)-1 trial evaluated the effects of metoprolol vs. placebo in 8351 patients, and POISE-2 compared the effect of aspirin vs. placebo, and clonidine vs. placebo in 10 010 patients. These trials included patients with, or at risk of, cardiovascular disease who were undergoing non-cardiac surgery. For the purpose of this study, we combined the POISE datasets, excluding 244 patients who were in atrial fibrillation (AF) at the time of randomization. Perioperative atrial fibrillation was defined as new AF that occurred within 30 days after surgery. Our primary outcome was the incidence of stroke at 1 year of follow-up; secondary outcomes were mortality and myocardial infarction (MI). We compared outcomes among patients with and without POAF using multivariable adjusted Cox proportional hazards models. Among 18 117 patients (mean age 69 years, 57.4% male), 404 had POAF (2.2%). The stroke incidence 1 year after surgery was 5.58 vs. 1.54 per 100 patient-years in patients with and without POAF, adjusted hazard ratio (aHR) 3.43, 95% confidence interval (CI) 2.00-5.90; P < 0.001. Patients with POAF also had an increased risk of death (incidence 31.37 vs. 9.34; aHR 2.51, 95% CI 2.01-3.14; P < 0.001) and MI (incidence 26.20 vs. 8.23; aHR 5.10, 95% CI 3.91-6.64; P < 0.001). CONCLUSION:Patients with POAF have a significantly increased risk of stroke, MI, and death at 1 year. Intervention studies are needed to evaluate risk reduction strategies in this high-risk population. Published on behalf of the European Society of Cardiology. All rights reserved.
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