【罂粟摘要】非心脏手术后新发心房颤动与随后卒中和短暂性脑缺血发作的关系

非心脏手术后术后房颤(AF)的结果尚不明确。

确定非心脏手术后新发房颤与无房颤与非致命性和致命性预后风险的关系。

在美国明尼苏达州奥姆斯特德县进行回顾性队列研究，涉及550例患者，他们在2000年至2013年接受了非心脏手术，术后30天内首次记录到AF。在这些患者中，452例患者在年龄、性别、手术年份和手术类型上与手术后30d内未发生房颤（无房颤）的非心脏手术患者进行了1:1的匹配。

非心脏手术后发生房颤与未发生房颤患者之间的比较。

主要观察指标为缺血性卒中或短暂性脑缺血发作（TIA）情况。次要观察指标包括随后记录的房颤、全因死亡率和心血管死亡率。

在904例纳入配对分析的患者中，中位年龄为75岁（IQR，67~82岁），其中51.8%为男性。术后房颤患者的CHA2DS2-VASc评分显著高于非房颤组（中位数，4[IQR，2-5]比3[IQR，2-5]；P<0.001）。中位随访时间为5.4年（IQR，1.4-9.2年），共有71例缺血性卒中或TIA，266例随后记录的房颤发作，571例死亡，其中172例与心血管相关。术后发生房颤的患者发生缺血性卒中或短暂性脑缺血发作的风险显著高于无房颤的患者。术后房颤患者随后记录的房颤和全因死亡的风险在统计学上显著升高。术后有房颤和无房颤的患者心血管死亡风险无显著差异。

在接受非心脏手术的患者中，术后新发的房颤与没有房颤的患者相比，卒中或短暂性脑缺血发作的风险显著增加。然而，这些发现对术后房颤处理的影响，例如抗凝治疗的需要，需要在随机试验中进行调查。

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

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 Among 904 patients included in the matched analysis, the median age was 75 years (IQR, 67-82 years) and 51.8% of patients were men. Patients with postoperative AF had significantly higher CHA2DS2-VASc scores vs 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 had a statistically significantly higher risk of ischemic stroke or TIA vs those with no AF. Patients with postoperative AF had statistically significantly higher risks of subsequent documented AF and all-cause death. No significant difference in the risk of cardiovascular death was observed for patients with and without postoperative AF.

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.