非心脏手术后新发房颤增加卒中和短暂性脑缺血
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非心脏手术后新发房颤增加卒中和短暂性脑缺血
2017-10-15

本期文章:《美国医学会杂志》:Vol 324 No 9

美国梅奥诊所Alanna M. Chamberlain团队研究了非心脏手术后新发房颤与卒中和短暂性脑缺血发作的相关性。2020年9月1日,该研究发表在《美国医学会杂志》上。

非心脏手术后房颤(AF)的预后尚不明确。为了确定非心脏手术后新发房颤或无房颤与非致命性和致命性结局风险之间的相关性,研究组在明尼苏达州进行了一项回顾性队列研究,招募了550例在2000-2013年间接受过非心脏手术且在术后30天发生房颤的患者。有452例患者在年龄、性别、手术年份和手术类型上与非心脏手术后30天内未发生房颤的患者1:1相匹配。主要结局为缺血性中风或短暂性脑缺血发作(TIA)。次要结局包括后续房颤、全因死亡和心血管疾病死亡。

452对匹配患者的中位年龄为75岁,其中51.8%为男性。术后房颤患者的CHA2DS2-VASc评分显著高于无房颤患者。中位随访5.4年后,共发生71次缺血性中风或TIA,266次后续AF发作和571例死亡,其中172例与心血管有关。术后房颤组的缺血性中风或TIA发生率为每1000人年18.9例,显著高于无房颤组(10.0例)。术后房颤组患者后续房颤的发生率和全因死亡率分别为每1000人年136.4例和133.2例,均显著高于无房颤组(21.6例和86.8例)。两组间心血管死亡的风险无显著差异。

总之,接受非心脏手术的患者术后新发房颤与无房颤相比,卒中或TIA风险显著增加。

附:英文原文

Title: Association of New-Onset Atrial Fibrillation After Noncardiac Surgery With Subsequent Stroke and Transient Ischemic Attack

Author: Konstantinos C. Siontis, Bernard J. Gersh, Susan A. Weston, Ruoxiang Jiang, Anthony H. Kashou, Véronique L. Roger, Peter A. Noseworthy, Alanna M. Chamberlain

Issue&Volume: 2020/09/01

Abstract:

Importance  Outcomes of postoperative atrial fibrillation (AF) after noncardiac surgery are not well defined.

Objective  To determine the association of new-onset postoperative AF vs no AF after noncardiac surgery with risk of nonfatal and fatal outcomes.

Design, Setting, and Participants  Retrospective cohort study in Olmsted County, Minnesota, involving 550 patients who had their first-ever documented AF within 30 days after undergoing a noncardiac surgery (postoperative AF) between 2000 and 2013. Of these patients, 452 were matched 1:1 on age, sex, year of surgery, and type of surgery to patients with noncardiac surgery who were not diagnosed with AF within 30 days following the surgery (no AF). The last date of follow-up was December 31, 2018.

Exposures  Postoperative AF vs no AF after noncardiac surgery.

Main Outcomes and Measures  The primary outcome was ischemic stroke or transient ischemic attack (TIA). Secondary outcomes included subsequent documented AF, all-cause mortality, and cardiovascular mortality.

Results  The median age of the 452 matched patients was 75 years (IQR, 67-82 years) and 51.8% of patients were men. Patients with postoperative AF had significantly higher CHA2DS2-VASc scores than those in the no AF group (median, 4 [IQR, 2-5] vs 3 [IQR, 2-5]; P<.001). Over a median follow-up of 5.4 years (IQR, 1.4-9.2 years), there were 71 ischemic strokes or TIAs, 266 subsequent documented AF episodes, and 571 deaths, of which 172 were cardiovascular related. Patients with postoperative AF exhibited a statistically significantly higher risk of ischemic stroke or TIA (incidence rate, 18.9 vs 10.0 per 1000 person-years; absolute risk difference [RD] at 5 years, 4.7%; 95% CI, 1.0%-8.4%; HR, 2.69; 95% CI, 1.35-5.37) compared with those with no AF. Patients with postoperative AF had statistically significantly higher risks of subsequent documented AF (incidence rate 136.4 vs 21.6 per 1000 person-years; absolute RD at 5 years, 39.3%; 95% CI, 33.6%-45.0%; HR, 7.94; 95% CI, 4.85-12.98), and all-cause death (incidence rate, 133.2 vs 86.8 per 1000 person-years; absolute RD at 5 years, 9.4%; 95% CI, 4.9%-13.7%; HR, 1.66; 95% CI, 1.32-2.09). No significant difference in the risk of cardiovascular death was observed for patients with and without postoperative AF (incidence rate, 42.5 vs 25.0 per 1000 person-years; absolute RD at 5 years, 6.2%; 95% CI, 2.2%-10.4%; HR, 1.51; 95% CI, 0.97-2.34).

Conclusions and Relevance  Among patients undergoing noncardiac surgery, new-onset postoperative AF compared with no AF was associated with a significant increased risk of stroke or TIA. However, the implications of these findings for the management of postoperative AF, such as the need for anticoagulation therapy, require investigation in randomized trials.

DOI: 10.1001/jama.2020.12518

Source: https://jamanetwork.com/journals/jama/article-abstract/2770009

期刊信息

JAMA-Journal of The American Medical Association:《美国医学会杂志》,创刊于1883年。隶属于美国医学协会,最新IF:51.273
官方网址:https://jamanetwork.com/
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