International Stroke Conference 2025  /  Risk Factors and Prevention Moderated Poster Tour II  /  Association Between Race/Ethnicity and New Onset Atrial Fibrillation and Stroke Following Noncardiac Surgery
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American Heart Association

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Final ID: TMP97

Association Between Race/Ethnicity and New Onset Atrial Fibrillation and Stroke Following Noncardiac Surgery

Abstract Body: Background
Racial differences in postoperative atrial fibrillation (POAF) and stroke rates following noncardiac surgery are not well understood and may be influenced by varying betablocker prescription patterns.1
Methods
This multicentric retrospective observational study included 205,886 adult patients without pre-existing atrial fibrillation who underwent non-cardiac surgery between 2005 and 2021 at two tertiary care academic healthcare networks in the Bronx, New York, and Boston, Massachusetts. The study population consisted of 133,500 (65%) Non-Hispanic White (NHW), 38,237 (19%) Non-Hispanic Black (NHB), and 34,149 (17%) Hispanic individuals. The exposure variable was self-identified race and ethnicity with NHW patients serving as the reference group. The incidence of POAF within 30 days of surgery and postoperative stroke within the first year after the procedure were assessed. Modified Poisson regression with robust error variances was used to evaluate the association between race/ethnicity and POAF and postoperative stroke, adjusting for pre-defined confounders. Mediation analysis was used to determine whether beta-blocker use modified the association between race/ethnicity and stroke.
Results
NHB and Hispanic patients were less likely to develop POAF than NHW patients (NHB: RRadj = 0.59; 95%CI: 0.52-0.68; P < .001; Hispanic: RRadj = 0.65; 95%CI: 0.56-0.76; P < .001) but more likely to experience postoperative stroke (NHB: RRadj = 1.39; 95%CI, 1.30-1.49; P < .001; Hispanic: RRadj = 1.34; 95%CI, 1.24-1.46; P < .001). NHB and Hispanic patients were also more likely to be on preexisting beta-blocker therapy than NHW patients (NHB: RRadj = 1.10; 95%CI: 1.07-1.14; P < .001; Hispanic: RRadj = 1.07; 95%CI: 1.03-1.12; P < .001). Beta-blocker use was significantly associated with an increased risk of postoperative stroke (RRadj = 1.17; 95%CI: 1.11-1.24; P < .001) and explained 16% (95%CI: 14%-20%) and 20% (95%CI: 16%-26%) of the variability in postoperative stroke rates among NHB and Hispanic patients, respectively.
Conclusion
NHB and Hispanic patients are at higher risk of developing postoperative stroke following noncardiac surgery compared to NHW patients, despite having a lower risk of POAF. This increased stroke risk may be partially attributable to the higher likelihood of preoperative beta-blocker prescriptions in these populations.
Reference
1 - POISE Study Group. The Lancet. 2008 May 31;371(9627):1839-47.
  • Rudolph, Maira  ( Montefiore Medical Center , New York , New York , United States )
  • Garcia, Mario  ( Montefiore Medical Center , Bronx , New York , United States )
  • Stiles, Brendon  ( Montefiore Medical Center , Bronx , New York , United States )
  • Bhatt, Deepak  ( Mount Sinai Fuster Heart Hospital , Scarsdale , New York , United States )
  • Nafiu, Olubukola  ( Nationwide Children's Hospital , Columbus , Ohio , United States )
  • Eikermann, Matthias  ( Montefiore Medical Center , New York , New York , United States )
  • Karaye, Ibraheem  ( Montefiore Medical Center , New York , New York , United States )
  • Mpody, Christian  ( Montefiore Medical Center , New York , New York , United States )
  • Borngaesser, Felix  ( Montefiore Medical Center , New York , New York , United States )
  • Wongtangman, Karuna  ( Siriraj hospital,Mahidol University , Bangkok , Thailand )
  • Wachtendorf, Luca Johann  ( Beth Israel Deaconess Medical Centre, Harvard Medical School , Boston , Massachusetts , United States )
  • Khandaker, Rafi  ( Montefiore Medical Center , New York , New York , United States )
  • Suleiman, Aiman  ( Montefiore Medical Center , New York , New York , United States )
  • Schaefer, Maximilian  ( Beth Israel Deaconess Medical Centre, Harvard Medical School , Boston , Massachusetts , United States )
  • Di Biase, Luigi  ( Montefiore Medical Center , Bronx , New York , United States )
    • Author Disclosures:
    Maira Rudolph: DO NOT have relevant financial relationships | Mario Garcia: DO NOT have relevant financial relationships | Brendon Stiles: No Answer | Deepak Bhatt: DO have relevant financial relationships ; Advisor:Angiowave, Bayer, Boehringer Ingelheim, CellProthera, Cereno Scientific, Elsevier Practice Update Cardiology, High Enroll, Janssen, Level Ex, McKinsey, Medscape Cardiology, Merck, MyoKardia, NirvaMed, Novo Nordisk, PhaseBio, PLx Pharma, Stasys:Active (exists now) ; Other (please indicate in the box next to the company name):Honoraria cont: Journal of the American College of Cardiology (Guest Editor; Associate Editor), K2P (Co-Chair, interdisciplinary curriculum), Level Ex, Medtelligence/ReachMD (CME steering committees), MJH Life Sciences, Oakstone CME (Course Director, Comprehensive Review of Interventional Cardiology), Piper Sandler, Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and USA national co-leader, funded by Bayer), WebMD (CME steering committees), Wiley (steering committee);:Active (exists now) ; Other (please indicate in the box next to the company name):Trustee: American College of Cardiology; Unfunded Research: FlowCo.:Active (exists now) ; Other (please indicate in the box next to the company name):Site Co-Investigator: Abbott, Biotronik, Boston Scientific, CSI, Endotronix, St. Jude Medical (now Abbott), Philips, SpectraWAVE, Svelte, Vascular Solutions;:Active (exists now) ; Royalties/Patent Beneficiary:Royalties: Elsevier (Editor, Braunwald’s Heart Disease);:Active (exists now) ; Research Funding (PI or named investigator):Abbott, Acesion Pharma, Afimmune, Aker Biomarine, Alnylam, Amarin, Amgen, AstraZeneca, Bayer, Beren, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, Cardax, CellProthera, Cereno Scientific, Chiesi, CinCor, Cleerly, CSL Behring, Eisai, Ethicon, Faraday Pharmaceuticals, Ferring Pharmaceuticals, Forest Laboratories, Fractyl, Garmin, HLS Therapeutics, Idorsia, Ironwood, Ischemix, Janssen, Javelin, Lexicon, Lilly, Medtronic, Merck, Moderna, MyoKardia, NirvaMed, Novartis, Novo Nordisk, Otsuka, Owkin, Pfizer, PhaseBio, PLx Pharma, Recardio, Regeneron, Reid Hoffman Foundation, Roche, Sanofi, Stasys, Synaptic, The Medicines Company, Youngene, 89Bio;:Active (exists now) ; Royalties/Patent Beneficiary:Sotagliflozin (named on a patent for sotagliflozin assigned to Brigham and Women's Hospital who assigned to Lexicon; neither I nor Brigham and Women's Hospital receive any income from this patent);:Active (exists now) ; Other (please indicate in the box next to the company name):Other: Clinical Cardiology (Deputy Editor);:Active (exists now) ; Other (please indicate in the box next to the company name):American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org; Chair, ACC Accreditation Oversight Committee), Arnold and Porter law firm (work related to Sanofi/Bristol-Myers Squibb clopidogrel litigation), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim; AEGIS-II executive committee funded by CSL Behring), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Canadian Medical and Surgical Knowledge Translation Research Group (clinical trial steering committees), CSL Behring (AHA lecture), Cowen and Company, Duke Clinical Research Institute (clinical trial steering committees, including for the PRONOUNCE trial, funded by Ferring Pharmaceuticals), HMP Global (Editor in Chief, Journal of Invasive Cardiology),:Active (exists now) ; Other (please indicate in the box next to the company name):Data Monitoring Committees: Acesion Pharma, Assistance Publique-Hôpitaux de Paris, Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), Boston Scientific (Chair, PEITHO trial), Cleveland Clinic, Contego Medical (Chair, PERFORMANCE 2), Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi Sankyo; for the ABILITY-DM trial, funded by Concept Medical; for ALLAY-HF, funded by Alleviant Medical), Novartis, Population Health Research Institute; Rutgers University (for the NIH-funded MINT Trial);:Active (exists now) ; Consultant:Broadview Ventures, GlaxoSmithKline, Hims, SFJ, Youngene:Active (exists now) ; Individual Stocks/Stock Options:Board of Directors: Angiowave (stock options), Bristol Myers Squibb (stock), DRS.LINQ (stock options), High Enroll (stock):Active (exists now) ; Other (please indicate in the box next to the company name):Board of Directors: American Heart Association New York City, Angiowave (stock options), Bristol Myers Squibb (stock), DRS.LINQ (stock options), High Enroll (stock):Active (exists now) | Olubukola Nafiu: No Answer | Matthias Eikermann: DO NOT have relevant financial relationships | Ibraheem Karaye: No Answer | Christian Mpody: No Answer | Felix Borngaesser: DO NOT have relevant financial relationships | Karuna Wongtangman: DO NOT have relevant financial relationships | Luca Johann Wachtendorf: DO NOT have relevant financial relationships | Rafi Khandaker: DO NOT have relevant financial relationships | Aiman Suleiman: DO NOT have relevant financial relationships | Maximilian Schaefer: DO NOT have relevant financial relationships | Luigi Di Biase: No Answer
Meeting Info:

International Stroke Conference 2025

2025

Los Angeles, CA

Session Info:

Risk Factors and Prevention Moderated Poster Tour II

Thursday, 02/06/2025 , 06:00PM - 07:00PM

Moderated Poster Abstract Session

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