TY - JOUR
T1 - Early Thromboembolic Stroke Risk of Postoperative Atrial Fibrillation Following Cardiac Surgery
AU - Pierik, Ramon
AU - Zeillemaker-Hoekstra, Miriam
AU - Scheeren, Thomas W L
AU - Erasmus, Michiel E
AU - Luijckx, Gert-Jan R
AU - Rienstra, Michiel
AU - Uyttenboogaart, Maarten
AU - Nijsten, Maarten
AU - van den Bergh, Walter M
N1 - Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.
PY - 2022/3
Y1 - 2022/3
N2 - OBJECTIVE: The authors aimed to study the association between postoperative atrial fibrillation (POAF) and thromboembolic stroke and to determine risk factors for thromboembolic stroke after cardiac surgery.DESIGN: The authors performed a secondary analysis from a randomized controlled trial (GRIP-COMPASS). The patients with thromboembolic stroke were compared with those without thromboembolic stroke, and the difference in the incidence of POAF between these groups was assessed. Odds ratios (OR) were calculated using logistic regression analyses. Brain imaging was studied for the occurrence of thromboembolic stroke during hospital admission, and POAF was monitored for seven days. To assess which characteristics were associated with occurrence of thromboembolic stroke, stepwise backward regression analysis was performed.PARTICIPANTS: All adult consecutive cardiac surgery patients admitted postoperatively to the intensive care unit.SETTING: Academic tertiary care medical center.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: Of the 910 patients included in this study, 26 patients (2.9%) had a thromboembolic stroke during hospital admission. The incidence of POAF during the first seven days after cardiac surgery in those with thromboembolic stroke was 65%, compared with 39% in those without thromboembolic stroke: adjusted OR 3.01 (95% confidence interval, 1.13-8.00). POAF, a history of peripheral vascular disease, a higher EuroSCORE, and a longer duration of surgery were associated with thromboembolic stroke.CONCLUSIONS: POAF within seven days after cardiac surgery was associated with a three-fold increased risk for a thromboembolic stroke during hospital admission. Expeditious treatment of POAF may, therefore, reduce early stroke risk after cardiac surgery.
AB - OBJECTIVE: The authors aimed to study the association between postoperative atrial fibrillation (POAF) and thromboembolic stroke and to determine risk factors for thromboembolic stroke after cardiac surgery.DESIGN: The authors performed a secondary analysis from a randomized controlled trial (GRIP-COMPASS). The patients with thromboembolic stroke were compared with those without thromboembolic stroke, and the difference in the incidence of POAF between these groups was assessed. Odds ratios (OR) were calculated using logistic regression analyses. Brain imaging was studied for the occurrence of thromboembolic stroke during hospital admission, and POAF was monitored for seven days. To assess which characteristics were associated with occurrence of thromboembolic stroke, stepwise backward regression analysis was performed.PARTICIPANTS: All adult consecutive cardiac surgery patients admitted postoperatively to the intensive care unit.SETTING: Academic tertiary care medical center.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: Of the 910 patients included in this study, 26 patients (2.9%) had a thromboembolic stroke during hospital admission. The incidence of POAF during the first seven days after cardiac surgery in those with thromboembolic stroke was 65%, compared with 39% in those without thromboembolic stroke: adjusted OR 3.01 (95% confidence interval, 1.13-8.00). POAF, a history of peripheral vascular disease, a higher EuroSCORE, and a longer duration of surgery were associated with thromboembolic stroke.CONCLUSIONS: POAF within seven days after cardiac surgery was associated with a three-fold increased risk for a thromboembolic stroke during hospital admission. Expeditious treatment of POAF may, therefore, reduce early stroke risk after cardiac surgery.
KW - stroke
KW - atrial fibrillation
KW - cardiac surgery
KW - HIGH POTASSIUM CONTROL
KW - GUIDED NORMAL-LOW
KW - OUTCOMES
KW - MORTALITY
U2 - 10.1053/j.jvca.2021.07.030
DO - 10.1053/j.jvca.2021.07.030
M3 - Article
C2 - 34454821
SN - 1053-0770
VL - 36
SP - 807
EP - 814
JO - Journal of cardiothoracic and vascular anesthesia
JF - Journal of cardiothoracic and vascular anesthesia
IS - 3
ER -