Major Adverse Cardiovascular Events Associated with Post-Operative Atrial Fibrillation after Non-Cardiac Surgery: A Systematic Review and Meta-analysis.

Background - Post-operative atrial fibrillation (POAF) is a frequent occurrence after non-cardiac 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 non-cardiac surgery by a meta-analysis of randomized controlled studies and observational studies. Methods - We searched electronic databases from inception up to August 1st, 2019 for all studies that reported stroke or myocardial infarction in adult patients who developed POAF following non-cardiac surgery. We used random-effects models to summarize the studies. Results - The final analyses included 28 studies enrolling 2,612,816 patients. At one-month (ten studies), POAF was associated with an approximately three-fold increase in the risk of stroke (weighted mean 2.1% vs 0.7%) [odds ratio (OR) 2.82 (95% Confidence intervals (CI): 2.15-3.70); p< 0.001]. POAF was associated with approximately four-fold increase in the long-term risk of stroke with (weighted mean 2.0% vs 0.6%) (OR 4.12, 95% CI: 3.32-5.11; pȦ4;0.001) in eight studies with Ȧ5;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% vs 0.9%) (OR 3.44,95% CI: 2.38-4.98; p<0.001) and (weighted mean 12.6% vs 2.7%) (OR 4.02, 95% CI: 3.08-5.24; p<0.001) respectively. Furthermore, POAF was associated with a three-fold increase in all-cause mortality at 30 days (weighted mean 15.0% vs 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 non-cardiac 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.