Perioperative atrial fibrillation and the long-term risk of ischemic stroke
Open accessAbstract
IMPORTANCE: Clinically apparent atrial fibrillation increases the risk of ischemic stroke. In contrast, perioperative atrial fibrillation may be viewed as a transient response to physiological stress, and the long-term risk of stroke after perioperative atrial fibrillation is unclear. OBJECTIVE: To examine the association between perioperative atrial fibrillation and the long-term risk of stroke. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study using administrative claims data on patients hospitalized for surgery (as defined by surgical diagnosis related group codes), and discharged alive and free of documented cerebrovascular disease or preexisting atrial fibrillation from nonfederal California acute care hospitals between 2007 and 2011. Patients undergoing cardiac vs other types of surgery were analyzed separately. MAIN OUTCOMES AND MEASURES: Previously validated diagnosis codes were used to identify ischemic strokes after discharge from the index hospitalization for surgery. The primary predictor variable was atrial fibrillation newly diagnosed during the index hospitalization, as defined by previously validated present-on-admission codes. Patients were censored at postdischarge emergency department encounters or hospitalizations with a recorded diagnosis of atrial fibrillation. RESULTS: Of 1,729,360 eligible patients, 24,711 (1.43%; 95% CI, 1.41%-1.45%) had new-onset perioperative atrial fibrillation during the index hospitalization and 13,952 (0.81%; 95% CI, 0.79%-0.82%) experienced a stroke after discharge. At 1 year after hospitalization for cardiac surgery, cumulative rates of stroke were 0.99% (95% CI, 0.81%-1.20%) in those with perioperative atrial fibrillation and 0.83% (95% CI, 0.76%-0.91%) in those without atrial fibrillation. At 1 year after noncardiac surgery, cumulative rates of stroke were 1.47% (95% CI, 1.24%-1.75%) in those with perioperative atrial fibrillation and 0.36% (95% CI, 0.35%-0.37%) in those without atrial fibrillation. In a Cox proportional hazards analysis accounting for potential confounders, perioperative atrial fibrillation was associated with subsequent stroke both after cardiac surgery (hazard ratio, 1.3; 95% CI, 1.1-1.6) and noncardiac surgery (hazard ratio, 2.0; 95% CI, 1.7-2.3). The association was significantly stronger for perioperative atrial fibrillation after noncardiac vs cardiac surgery (P < .001 for interaction). CONCLUSIONS AND RELEVANCE: Among patients hospitalized for surgery, perioperative atrial fibrillation was associated with an increased long-term risk of ischemic stroke, especially following noncardiac surgery.
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In the long term, patients with an episode of postoperative AF have a twofold increase in cardiovascular mortality and a substantially increased risk of future AF and ischaemic stroke compared with patients that remain in sinus rhythm after surgery.
“In the long term, patients with an episode of postoperative AF have a twofold increase in cardiovascular mortality and a substantially increased risk of future AF and ischaemic stroke compared with patients that remain in sinus rhythm after surgery.952-958”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [953]
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2018 ESC/EACTS guidelines on myocardial revascularization
Neumann, F.-J., Sousa-Uva, M., Ahlsson, A., Alfonso, F., Banning, A. P., Benedetto, U., Byrne, R. A., Collet, J.-P., Falk, V., Head, S. J., et al. (2019) · European Heart Journal · doi:10.1093/eurheartj/ehy394 · Cited by 7,167 · see citing works
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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- Authors
- Gialdini, G., Nearing, K., Bhave, P. D., Bonuccelli, U., Iadecola, C., Healey, J. S., & Kamel, H.
- Affiliations
- Weill Cornell Medicine (US)
- University of Iowa (US)
- University of Pisa (IT)
- Population Health Research Institute (CA)
- Corresponding author
- Kamel, Hooman
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2014-08-13
- Volume
- 312
- Issue
- 6
- Pages
- 616
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC4277813
- OpenAlex
- W2089212627
- Cited by
- 355
- References
- 38
- Citations by year
- 2026: 12 · 2025: 21 · 2024: 31 · 2023: 17 · 2022: 37 · 2021: 49 · 2020: 45 · 2019: 36 · 2018: 33 · 2017: 23 · 2016: 28 · 2015: 19 · 2014: 4
- FWCI
- 16.90
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- Funders
- Bristol-Myers Squibb
- Heart and Stroke Foundation of Canada (MC7450)
- Boston Scientific Corporation
- Genentech
- National Institute of Neurological Disorders and Stroke (K23NS082367, R01NS034179, R01NS037853)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Keywords
- perioperative atrial fibrillation, ischemic stroke, long-term stroke risk, cardiac surgery, non-cardiac surgery, postoperative complications, atrial fibrillation incidence, stroke risk stratification
- MeSH terms
- Adult, Aged, Atrial Fibrillation, Female, Hospitalization, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, Surgical Procedures, Operative, Proportional Hazards Models, Stroke, Kaplan-Meier Estimate, Perioperative Period
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