Short-term and Long-term Risk of Stroke in Patients With Perioperative Atrial Fibrillation After Cardiac Surgery: Systematic Review and Meta-analysis

被引：24

作者：

Wang, Michael K. ^{[1
,2
,3
,12
]}

Meyre, Pascal B. ^{[4
]}

Heo, Rachel ^{[5
]}

Devereaux, P. J. ^{[1
,2
,3
]}

Birchenough, Lauren ^{[6
]}

Whitlock, Richard ^{[2
,3
,7
]}

Mcintyre, William F. ^{[1
,2
,3
]}

Chen, Yu Chiao Peter ^{[8
]}

Ali, Muhammad Zain ^{[9
]}

Biancari, Fausto ^{[10
]}

Butt, Jawad Haider ^{[11
]}

Healey, Jeff S. ^{[1
,2
,3
]}

Belley-Cote, Emilie P. ^{[1
,2
]}

Lamy, Andre ^{[2
,3
,7
]}

Conen, David ^{[1
,2
,3
]}

机构：

[1] McMaster Univ, Dept Med, Hamilton, ON, Canada

[2] McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada

[3] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada

[4] Basel Univ Hosp, Basel Cardiovasc Res Inst, Div Cardiol, Basel, Switzerland

[5] McMaster Univ, Michael G DeGroote Sch Med, Hamilton, ON, Canada

[6] McMaster Univ, Fac Hlth Sci, Hamilton, ON, Canada

[7] McMaster Univ, Dept Surg, Hamilton, ON, Canada

[8] Univ British Columbia, Dept Med, Vancouver, BC, Canada

[9] Royal Coll Surgeons Ireland, Sch Med, Dublin, Ireland

[10] GVM Care & Res, Clin Montevergine, Mercogliano, Italy

[11] Copenhagen Univ Hosp, Dept Cardiol, Rigshopitalet, Copenhagen, Denmark

[12] 237 Barton St East, Hamilton, ON L8L 2X2, Canada

来源：

CJC OPEN | 2022年 / 4卷 / 01期

关键词：

AORTIC-VALVE-REPLACEMENT; BYPASS GRAFT-SURGERY; LATE MORTALITY; IMPACT; PREDICTORS; ANTICOAGULATION; MANAGEMENT; BIAS;

D O I：

10.1016/j.cjco.2021.09.011

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Perioperative atrial fibrillation (POAF) after cardiac surgery has been associated with an increased risk of stroke in some studies. However, the exact magnitude of this association during short -term and long-term follow-up remains unclear.Methods: We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) for the time period from database inception to October 2020. We included observational studies with = 100 patients that reported data on short-term or long-term stroke risk in patients with and without POAF after cardiac surgery. Data were pooled using random-effects models. We reported summary risk ratios (RRs) for studies reporting multivariable adjusted results and calculated absolute risk differences (ARDs) with 95% confidence intervals (CIs).Results: A total of 55 studies with 540,209 patients were included. POAF was associated with both an increased relative risk (RR 1.69; 95% CI, 1.41-2.03; I-2 = 82%; 9 studies) and absolute risk of short-term stroke (4.5% vs 2.5%; ARD 2.0%; 95% CI, 1.28-2.89). POAF was associated with an increased relative risk (RR 1.20; 95% CI, 1.12-1.29; I-2 = 16%; 10 studies) and absolute risk of long-term stroke (1.06 vs 0.88 per 100 patient-years; ARD 0.18 per 100 patient-years; 95% CI, 0.07-0.26). Sensitivity analyses of high-quality studies and studies reporting either ischemic or embolic strokes yielded similar findings.Conclusions: POAF after cardiac surgery was associated with an increased risk of both short-term and long-term stroke. However, the long-term stroke ARD was small, and whether these patients will benefit from long-term oral anticoagulation therapy is unclear.

引用

页码：85 / 96

页数：12

共 80 条

[1] Postoperative atrial fibrillation in patients undergoing aortocoronary bypass surgery carries an eightfold risk of future atrial fibrillation and a doubled cardiovascular mortality [J].