• Wojciech Szczeklik, Yannick LeManach, Jakub Fronczek, Kamil Polok, David Conen, Finlay A McAlister, Sadeesh Srinathan, Pablo Alonso-Coello, Bruce Biccard, Emmanuelle Duceppe, Diane Heels-Ansdell, Jacek Górka, Shirley Pettit, Pavel S Roshanov, and P J Devereaux.
• Department of Intensive Care and Perioperative Medicine (Szczeklik, Fronczek, Polok, Górka), Jagiellonian University Medical College, Kraków, Poland; Population Health Research Institute (LeManach, Conen, Duceppe, Pettit, Devereaux) and Department of Health Research Methods, Evidence, and Impact (LeManach, Conen, Heels-Ansdell), McMaster University, Hamilton, Ont.; Division of General Internal Medicine, Department of Medicine (McAlister), University of Alberta, Edmonton, Alta.; Department of Surgery (Srinathan), University of Manitoba, Winnipeg, Man.; Iberoamerican Cochrane Center (Alonso-Coello), Biomedical Research Institute Sant Pau (IIB-Sant Pau-CIBERESP), Barcelona, Spain; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital and University of Cape Town, South Africa; Division of Nephrology (Roshanov), Department of Medicine, London Health Sciences Centre, London, Ont. wojciech.szczeklik@uj.edu.pl.
• CMAJ. 2020 Dec 7; 192 (49): E1715-E1722.

BackgroundPostoperative atrial fibrillation (POAF) is associated with clinically significant short- and long-term complications after noncardiac surgery. Our aim was to describe the incidence of clinically important POAF after noncardiac surgery and establish the prognostic value of N-terminal pro-brain-type natriuretic peptide (NT-proBNP) in this context.MethodsThe Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION) Study was a prospective cohort study involving patients aged 45 years and older who had inpatient noncardiac surgery that was performed between August 2007 and November 2013. We determined 30-day incidence of clinically important POAF (i.e., resulting in angina, congestive heart failure, symptomatic hypotension or requiring treatment) using logistic regression models to analyze the association between preoperative NT-proBNP and POAF.ResultsIn 37 664 patients with no history of atrial fibrillation, we found that the incidence of POAF was 1.0% (95% confidence interval [CI] 0.9%-1.1%; 369 events); 3.2% (95% CI 2.3%-4.4%) in patients undergoing major thoracic surgery, 1.3% (95% CI 1.2%-1.5%) in patients undergoing major nonthoracic surgery and 0.2% (95% CI 0.1%-0.3%) in patients undergoing low-risk surgery. In a subgroup of 9789 patients with preoperative NT-proBNP measurements, the biomarker improved the prediction of POAF risk over conventional prognostic factors (likelihood ratio test p < 0.001; fraction of new information from NT-proBNP was 16%). Compared with a reference NT-proBNP measurement set at 100 ng/L, adjusted odds ratios for the occurrence of POAF were 1.31 (95% CI 1.15-1.49) at 200 ng/L, 2.07 (95% CI 1.27-3.36) at 1500 ng/L and 2.39 (95% CI 1.26-4.51) at 3000 ng/L.InterpretationWe determined that the incidence of clinically important POAF after noncardiac surgery was 1.0%. We also found that preoperative NT-proBNP levels were associated with POAF independent of established prognostic factors. Trial registration: ClinicalTrials.gov, no. NCT00512109.© 2020 Joule Inc. or its licensors.

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