Elevated risk of perioperative ischemic stroke in noncardiac surgery patients with atrial fibrillation: a retrospective cohort study.

Abstract

Background: Stroke is still a significant and growing challenge of global health, however, the impact of Atrial Fibrillation (AF) on the risk of perioperative stroke remains unclear.

Aim: This study aims to evaluate the clinical prognostic value of AF in patients undergoing noncardiac surgery, with perioperative ischemic stroke as the primary prognostic indicator.

Methods: A retrospective cohort study was conducted on patients who underwent noncardiac surgery between January 2008 and August 2019 at The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital. The study included patients with a procedure duration exceeding one hour. Participants were categorized into two groups: an AF group and a non-AF group, based on the presence or absence of AF. The primary outcome was the occurrence of perioperative ischemic stroke. To determine whether AF is an independent prognostic indicator, primary and subgroup analyses were performed. Logistic regression models were used to identify risk factors. Besides, sensitivity analysis, propensity score matching (PSM) analysis were applied to mitigate potential residual confounding effects and assess the robustness of the findings.

Results: The primary analysis demonstrated that patients in the AF group had a significantly higher risk of perioperative ischemic stroke (OR: 6.843; 95% CI: 3.73-11.413; P < 0.001). Further modeling analyses confirmed a significant correlation between AF and perioperative ischemic stroke across various models: model 2 (OR: 1.789; 95% CI: 0.958-3.053; P < 0.05), model 3 (OR: 5.121; 95% CI: 2.749-8.716; P < 0.001), and model 4 (OR: 2.122; 95% CI: 1.123-3.677; P < 0.05). Sensitivity analysis excluding neurosurgeries were conducted. The adjusted OR of perioperative ischemic stroke in neurosurgery patients with the AF was 1.623(95% CI: 0.359-5.165; P = 0.463). While, the association between AF and perioperative ischemic stroke remained stable in those non-neurosurgical patients (OR: 2.154;95% CI: 1.044-3.964; P = 0.023). After PSM adjustments, the association between AF and perioperative ischemic stroke remained significant (OR: 2.106; 95% CI: 1.003-4.159; P < 0.05). Subgroup analyses revealed that AF significantly increased the risk of perioperative ischemic stroke, particularly in males, patients aged ≥ 60.5 years, those with an ASA score ≥ 3, those with hypertension, and those not on antiplatelet medication.

Conclusion: Atrial fibrillation is an independent prognostic risk factor for perioperative ischemic stroke in patients undergoing noncardiac surgery, especially pronounced in specific subgroups, including males, elderly patients, those with high ASA scores, with hypertension, and not receiving antiplatelet therapy. These findings emphasize the need for heightened awareness and prompt clinical intervention in these high-risk patients.