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Risk of stroke and other adverse outcomes in patients with perioperative atrial fibrillation 1 year after non-cardiac surgery

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dc.contributor.author Conen, David
dc.contributor.author Alonso-Coello, Pablo
dc.contributor.author Douketis, James
dc.contributor.author Chan, Matthew T. V.
dc.contributor.author Kurz, Andrea
dc.contributor.author Sigamani, Alben
dc.contributor.author Parlow, Joel L.
dc.contributor.author Wang, Chew Yin
dc.contributor.author Villar, Juan C.
dc.contributor.author Srinathan, Sadeesh K.
dc.contributor.author Tiboni, Maria
dc.contributor.author Málaga Rodríguez, Germán Javier
dc.contributor.author Guyatt, Gordon
dc.contributor.author Sivakumaran, Soori
dc.contributor.author Rodriguez Funes, Maria-Virginia
dc.contributor.author Cruz, Patricia
dc.contributor.author Yang, Homer
dc.contributor.author Dresser, George K.
dc.contributor.author Alvarez-Garcia, Jesus
dc.contributor.author Schricker, Thomas
dc.contributor.author Jones, Philip M.
dc.contributor.author Drummond, Leanne W.
dc.contributor.author Balasubramanian, Kumar
dc.contributor.author Yusuf, Salim
dc.contributor.author Devereaux, P. J.
dc.date.accessioned 2019-07-04T17:00:23Z
dc.date.available 2019-07-04T17:00:23Z
dc.date.issued 2019
dc.identifier.uri https://hdl.handle.net/20.500.12866/6897
dc.description.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. en_US
dc.language.iso eng
dc.publisher Oxford University Press
dc.relation.ispartofseries European Heart Journal
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Atrial fibrillation en_US
dc.subject Cardiovascular en_US
dc.subject Mortality en_US
dc.subject Perioperative en_US
dc.subject Stroke en_US
dc.subject acetylsalicylic acid en_US
dc.subject adverse outcome en_US
dc.subject aged en_US
dc.subject Article en_US
dc.subject atrial fibrillation en_US
dc.subject cardiovascular risk en_US
dc.subject cerebrovascular accident en_US
dc.subject clonidine en_US
dc.subject cohort analysis en_US
dc.subject conservative treatment en_US
dc.subject controlled study en_US
dc.subject drug effect en_US
dc.subject female en_US
dc.subject follow up en_US
dc.subject high risk population en_US
dc.subject human en_US
dc.subject incidence en_US
dc.subject major clinical study en_US
dc.subject male en_US
dc.subject metoprolol en_US
dc.subject mortality rate en_US
dc.subject mortality risk en_US
dc.subject peroperative complication en_US
dc.subject placebo en_US
dc.subject postoperative period en_US
dc.subject priority journal en_US
dc.subject randomized controlled trial en_US
dc.subject risk factor en_US
dc.subject risk reduction en_US
dc.title Risk of stroke and other adverse outcomes in patients with perioperative atrial fibrillation 1 year after non-cardiac surgery en_US
dc.type info:eu-repo/semantics/review
dc.identifier.doi https://doi.org/10.1093/eurheartj/ehz431
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.04
dc.relation.issn 1522-9645


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