Perioperative/Postoperative Atrial Fibrillation and Risk of Subsequent Stroke and/or Mortality: A Meta-Analysis

Background and Purpose Although believed to be transient and self-limiting, new-onset perioperative/postoperative atrial fibrillation (POAF) might be a risk factor for stroke and mortality. We conducted a systematic review and meta-analysis to qualitatively and quantitatively evaluate the relationship of POAF with early and late risks of mortality and stroke. Methods We searched Pubmed, EMBASE, and Cochrane Library (1966 through March 2018) to identify cohort studies that reported stroke and mortality associated with POAF. We computed a random-effects estimate based on the Mantel-Haenszel method. Odds ratios with 95% CI were used as a measure of the association between POAF and early (in-hospital or within 30 days of surgery) stroke and mortality, while hazard ratios (HR) were used for long-term outcomes. Results Our analysis included 35 studies with 2458010 patients. Pooling the results from the random-effects model showed that POAF was associated with increased risks of early stroke (odds ratio, 1.62; 95% CI, 1.47-1.80), early mortality (odds ratios, 1.44; 95% CI, 1.11-1.88), long-term stroke (HR, 1.37; 95% CI, 1.07-1.77), and long-term mortality (HR, 1.37; 95% CI, 1.27-1.49). Analyses focusing on high-quality studies obtained similar results. In subgroup analyses, POAF was more strongly associated with stroke in patients undergoing noncardiac surgery (HR, 2.00; 95% CI, 1.70-2.35) than in patients undergoing cardiac surgery (HR, 1.20; 95% CI, 1.07-1.34). Conclusions New-onset POAF is associated with an increased risk of stroke and mortality, both in the short-term and long-term. The best strategy to reduce stroke risk among these patients needs to be determined.