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Clinical Implications of Preoperative Nonvalvular Atrial Fibrillation with Respect to Postoperative Cardiovascular Outcomes in Patients Undergoing Non-Cardiac Surgery

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Affiliated Author(s)
이철현
Alternative Author(s)
Lee, Cheol Hyun
Journal Title
Korean Circulation Journal
ISSN
1738-5555
Issued Date
2020
Keyword
Atrial fibrillationStrokeSurgeryRisk assessment
Abstract
Background and Objectives:
Atrial fibrillation (AF) is associated with a higher long-term risk of major cardiovascular events. However, its clinical implications with respect to peri-operative cardiovascular outcomes in patients undergoing non-cardiac surgery is unclear. We tried to examine the association between pre-operative AF and peri-operative cardiovascular outcomes.

Methods:
We retrospectively analyzed data from 26,501 consecutive patients who underwent comprehensive preoperative cardiac evaluations for risk stratification prior to receiving non-cardiac surgery at our center. Preoperative AF was diagnosed in 1,098 patients (4.1%), and their cardiovascular outcomes were compared with those of patients without AF. The primary outcome was the rate of major adverse cardiac and cerebrovascular events (MACCE) during immediate post-surgery period (<30 days).

Results:
Patients with AF were older and had higher proportion of male sex, higher rate of extra-cardiac comorbidities, higher CHA2DS2-VASc score, and higher revised cardiac risk index (RCRI) compared with those without AF. The rate of MACCE was significantly higher in AF patients compared to non-AF patients (4.6% vs. 1.2%, p<0.001). Preoperative AF was associated with higher risk of MACCE, even after multivariable adjustment (odds ratio, 2.97; 95% confidence interval, 2.13–4.07, p<0.001). The relative contribution of AF to MACCE was larger in patients with lower RCRI (p for interaction=0.010). The discriminating performance of RCRI was significantly enhanced by addition of AF.

Conclusions:
In patients undergoing non-cardiac surgery, preoperative AF was associated with a higher risk of peri-operative cardiovascular outcomes.
Department
Dept. of Internal Medicine (내과학)
Publisher
School of Medicine (의과대학)
Citation
Min Soo Cho et al. (2020). Clinical Implications of Preoperative Nonvalvular Atrial Fibrillation with Respect to Postoperative Cardiovascular Outcomes in Patients Undergoing Non-Cardiac Surgery. Korean Circulation Journal, 50(2), 148–159. doi: 10.4070/kcj.2019.0219
Type
Article
ISSN
1738-5555
DOI
10.4070/kcj.2019.0219
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/42552
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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