Clinical InvestigationElectrophysiologyWhich risk score best predicts perioperative outcomes in nonvalvular atrial fibrillation patients undergoing noncardiac surgery?
Section snippets
Study design and data sources
We established a population-based inception cohort of patients with NVAF who underwent noncardiac surgery at varying times after diagnosis of NVAF, and examined outcomes in the first 30 days after surgery. As previously described,22 the data set was created by linking 5 administrative databases in the province of Alberta, Canada, and following each NVAF case using each patient’s unique personal identifier: (1) the Alberta Inpatient Discharge Abstract Database, which records information for all
Results
The final study sample included 32,160 NVAF patients who underwent major or minor noncardiac surgery between April 1, 1999, and November 30, 2009 (Figure 1). The 30-day primary composite outcome of death, stroke, TIA, or SE was 4.2%; 30-day perioperative mortality rate was 3.3%; and the incidence of stroke, TIA, or SE in the first 30 days after surgery was 1.2%. Patients with perioperative events were older and more likely to have a history of hypertension, diabetes, coronary artery disease, a
Discussion
In this large population-based cohort of NVAF patients undergoing noncardiac surgery, we found that the CHADS2, CHA2DS2-VASc, and R2CHADS2 scores were all superior to the RCI for predicting risk of death and/or the risk of stroke, TIA, or SE in the first 30 days after surgery.
Despite an increasing prevalence of NVAF in the general population, the optimal means of preoperative risk stratification in this population has not been previously described.1 This may, in part, be due to the conflicting
Conclusions
In a large unselected population-based cohort of patients undergoing noncardiac surgery, we found that CHADS2, CHA2DS2-VASc, and R2CHADS2 were all modestly superior to RCI for the prediction of 30-day major perioperative events including mortality and/or stroke/TIA/SE. The observed NRI suggests that the 3 thromboembolic risk models evaluated can improve the preoperative risk stratification of patients with NVAF undergoing noncardiac surgery.
Funding
J. E. A. is supported by a salary award from Alberta Innovates—Health Solutions. F. A. M. is supported by Alberta Innovates—Health Solutions and the University of Alberta Chair in Cardiovascular Outcomes.
Conflicts of interest
S. v. D., E. Y., J. A. E., and F. A. M: none.
Acknowledgements
This study is based in part on data provided by Alberta Health. The interpretation and conclusions contained herein are those of the researchers and do not necessarily represent the views of the Government of Alberta. Neither the Government of Alberta nor Alberta Health expresses any opinion in relation to this study.
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2021, Canadian Journal of CardiologyCitation Excerpt :Data from these databases were linked using province health number to assemble the cohort of interest. Noncardiac surgeries and high-risk surgery (intrathoracic, suprainguinal vascular, and intraperitoneal) were identified using the Canadian Classification of Health Intervention codes, which have been previously described.20 RCRI score6 for each patient was calculated using 1-point assignments for the presence of each of the following variables: (1) history of ischemic heart disease; (2) heart failure; (3) stroke or transient ischemic attack; (4) insulin-treated diabetes; (5) creatinine ≥ 177 μmol/L; and (6) high-risk surgery (intrathoracic, vascular, and intraperitoneal), for a maximum score of 6.
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2019, International Journal of CardiologyCitation Excerpt :As an additional summary of incremental value, we aimed to evaluate R2CHADS2 via the net reclassification index (NRI). This method has been used to evaluate R2CHADS2 and many other risk scores in cardiology [4,8,16–18]. The result was inconsistent with other metrics of added value (leading to opposite conclusions); therefore, we engaged methodological experts, including the original author of the NRI, to understand this phenomenon.
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2015, Thoracic Surgery ClinicsCitation Excerpt :Perhaps the most well-known scoring method for the risk of ATE is the CHADS score and its subsequent modifications, including CHADS2 and CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years [2 points], diabetes mellitus, stroke or TIA [2 points], vascular disease, age 65 to 74, and sex category [female gender]) for patients with atrial fibrillation.19,20 Although an average risk of systemic embolization of 4.5% per year in all patients with nonvalvular atrial fibrillation has been reported, risk scores give a better estimate of the individual risk, which may vary from 1% to 20%.21–25 Scoring systems for VTE (eg, D-dimer, age, sex, and hormone therapy [DASH])26 have also been described but have not been as popular as ATE scores.
Renal function and outcomes after catheter ablation of patients with atrial fibrillation: The Guangzhou atrial fibrillation ablation registry
2019, Archives of Cardiovascular DiseasesCitation Excerpt :CKD and AF share many pathophysiological pathways, including those related to the renin-angiotensin-aldosterone system [19–21]. Left atrial enlargement significantly increases the risk of AF recurrence after single CA [22,23], and CKD may also result in cardiac and atrial structural changes through metabolic abnormalities [24] and oxidative stress [25]. The recurrent risk after a single CA procedure in patients with AF with CKD is increased significantly (57.4% vs. 33.5% for no CKD; P < 0.01) [6]; this is also evident in patients undergoing other energy ablations [26] or repeated radiofrequency ablations [27].
Management of antithrombotic drugs in patients comorbid with cardiovascular disease undergoing urological surgery
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