LONG-TERM RISK OF STROKE AFTER AN EPISODE OF ATRIAL FIBRILLATION OCCURRING TRANSIENTLY WITH STRESS FOLLOWING NON-CARDIAC SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Atrial fibrillation (AF) is one of the most common causes of stroke. AF occurring transiently with stress (AFOTS) describes a first episode of AF occurring after exposure to an acute reversible stressor, such as surgery or medical illness. Uncertainty exists regarding whether AFOTS is associated with an increased long-term risk of major adverse cardiovascular events. We performed a systematic review and meta-analysis aiming to determine the long-term risk of ischemic stroke and mortality after non-cardiac surgery in those who had AFOTS detected as compared to those who did not. The protocol was pre-registered with PROSPERO. We searched MEDLINE and EMBASE from inception to January 2017 for studies reporting on the long-term (≥30 days post-operatively) risk of stroke and mortality after an episode of AFOTS following non-cardiac surgery. Reference screening, study selection, data extraction, and quality assessment using the CLARITY tool were performed independently and in duplicate. Risk ratios were calculated using the inverse variance method. Data were pooled using a random-effects model. From 6252 unique citations, we identified 13 eligible studies with follow-up on 1,659,424 patients. Of these, 0.81% had AFOTS detected during their index hospitalization. A total of 1.05% of patients with AFOTS after non-cardiac surgery experienced an ischemic stroke during a mean follow-up of 25.20 ± 0.62 months, representing an increased risk when compared to patients who underwent non-cardiac surgery but did not have AFOTS detected (RR 2.86, 95% CI: 2.41-3.39, I2 = 0%). This risk was similar in the sub-group of patients who underwent thoracic surgery (RR 3.33, 95%CI: 0.91-12.14, I2 = 0%). AFOTS was also associated with a significantly higher risk of all-cause mortality (RR 1.72, 95%CI: 1.33-2.22, I2 = 76) (Table 1). Patients who had AFOTS detected after non-cardiac surgery have a higher long-term risk of ischemic stroke and mortality as compared to patients who did not have AFOTS detected. Whether this risk is modifiable with oral anticoagulation therapy should be investigated.