Abstract 14286: Risk of Stroke Associated With Atrial Fibrillation After Non-cardiac Surgery: Insights From a Meta-analysis of Randomized Controlled Studies and Observational Studies
Introduction: Post-operative atrial fibrillation (POAF) is a frequent occurrence after non-cardiac surgery. Due to its generally short duration, it remains uncertain whether POAF is associated with increased risk of stroke. We aim to elucidate the risk of stroke associated with POAF following non-cardiac surgery by a meta-analysis of randomized controlled studies and observational studies.
Methods: We searched MEDLINE, EMBASE, Web of Science, Scopus and clinicaltrials.gov from inception to April 6 2016, for all studies that reported strokes in patients who developed POAF after non-cardiac surgery. Two reviewers independently performed the search and extraction. We used a random-effects model to summarize the studies.
Results: From a total of 4364 abstracts screened, we retained 13 studies enrolling 1,694,663 patients for final analyses. 16,061 patients had POAF, in whom mean ages ranged from 60-72 years and females ranged from 21%-41%. In addition, 30%-72% were hypertensive, 11%-33% were diabetic and 15%-50% had coronary artery disease. In comparison, 1,678,602 patients did not have POAF. Their mean ages ranged from 56-72 years and females ranged from 22%-60%. Moreover, 22%-70% were hypertensive, 7%-31% were diabetic and 10%-40% had coronary artery disease. At one month follow-up, POAF was associated with approximately three times increase in risk of short-term stroke [odds ratio (OR): 3.09 (95% Confidence intervals (CI): 2.14-4.46); n=9 studies]. POAF was associated with approximately four times increase in long-term risk of stroke with OR: 3.97(95% CI: 3.46-4.57) in four studies with ≥12-month follow-up. Combining all 13 studies, the overall increase in risk of stroke associated with POAF was 3.84 (95% CI: 3.38-4.38) (Figure 1).
Conclusions: POAF was associated with increased short and long-term risk of stroke after non-cardiac surgery. Future studies are needed to evaluate the impact of anticoagulation in decreasing the risk of stroke in these patients.
Author Disclosures: A. AlTurki: None. M. Marafi: None. D. Cardinale: None. R. Blackwell: None. A. Bessissow: None. V. Essebag: None. J.S. Healey: None. T. Huynh: None.
- © 2016 by American Heart Association, Inc.