Wojciech Szczeklik1, Yannick LeManach2, Jakub Fronczek2, Kamil Polok2, David Conen2, Finlay A McAlister2, Sadeesh Srinathan2, Pablo Alonso-Coello2, Bruce Biccard2, Emmanuelle Duceppe2, Diane Heels-Ansdell2, Jacek Górka2, Shirley Pettit2, Pavel S Roshanov2, P J Devereaux2. 1. 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. wojciech.szczeklik@uj.edu.pl. 2. 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.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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 p < 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. INTERPRETATION: 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. Trial registration: ClinicalTrials.gov, no. NCT00512109.
BACKGROUND: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. METHODS: 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. RESULTS: 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 p < 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. INTERPRETATION: 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. Trial registration: ClinicalTrials.gov, no. NCT00512109.
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Authors: P J Devereaux; Bruce M Biccard; Alben Sigamani; Denis Xavier; Matthew T V Chan; Sadeesh K Srinathan; Michael Walsh; Valsa Abraham; Rupert Pearse; C Y Wang; Daniel I Sessler; Andrea Kurz; Wojciech Szczeklik; Otavio Berwanger; Juan Carlos Villar; German Malaga; Amit X Garg; Clara K Chow; Gareth Ackland; Ameen Patel; Flavia Kessler Borges; Emilie P Belley-Cote; Emmanuelle Duceppe; Jessica Spence; Vikas Tandon; Colin Williams; Robert J Sapsford; Carisi A Polanczyk; Maria Tiboni; Pablo Alonso-Coello; Atiya Faruqui; Diane Heels-Ansdell; Andre Lamy; Richard Whitlock; Yannick LeManach; Pavel S Roshanov; Michael McGillion; Peter Kavsak; Matthew J McQueen; Lehana Thabane; Reitze N Rodseth; Giovanna A Lurati Buse; Mohit Bhandari; Ignacia Garutti; Michael J Jacka; Holger J Schünemann; Olga Lucía Cortes; Pierre Coriat; Nazari Dvirnik; Fernando Botto; Shirley Pettit; Allan S Jaffe; Gordon H Guyatt Journal: JAMA Date: 2017-04-25 Impact factor: 56.272