A A Novel Risk Score to Predict New Onset Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Grafting
Background: Atrial fibrillation (AF) is common after cardiac surgery and contributes to increased morbidity and mortality. Our objective was to derive and validate a predictive model for AF after CABG in patients, incorporating novel echocardiographic and laboratory values.
Methods: We retrospectively reviewed patients at our institution without preexisting dysrhythmia who underwent on-pump, isolated CABG from 2011-2015. The primary outcome was new onset AF lasting >1 hour on continuous telemetry or requiring medical treatment. Patients with a preoperative echocardiographic measurement of left atrial diameter were included in a risk model, and were randomly divided into derivation (80%) and validation (20%) cohorts. The predictors of AF after CABG (PAFAC) score was derived from a multivariable logistic regression model by multiplying the adjusted odds ratios of significant risk factors (P < .05) by a factor of 4 to derive an integer point system.
Results: 1307 patients underwent isolated CABG, including 762/1307 patients with a preoperative left atrial diameter measurement. 209/762 patients (27%) developed new onset AF including 165/611 (27%) in the derivation cohort. We identified four risk factors independently associated with postoperative AF which comprised the PAFAC score: age > 60 years (5 points), White race (5 points), baseline GFR < 90 mL/min (4 points) and left atrial diameter > 4.5 cm
(4 points). Scores ranged from 0-18. The PAFAC score was then applied to the validation cohort and predicted incidence of AF strongly correlated with observed incidence (r = 0.92).
Conclusion: The PAFAC score is easy to calculate and can be used upon ICU admission to reliably identify patients at high risk of developing AF after isolated CABG.
Afzal AR, et al. 2008. Association of Met439Thr substitution in heat shock protein 70 gene with postoperative atrial fibrillation and serum HSP70 protein levels. Cardiology 110:45-52.
Almassi GH, et al. 1997. Atrial fibrillation after cardiac surgery: a major morbid event? Ann Surg 226:501-11; discussion 511-3.
Amar D, et al. 2004. Clinical prediction rule for atrial fibrillation after coronary artery bypass grafting. J Am Coll Cardiol 44:1248-53.
Arsenault KA, et al. 2013. Interventions for preventing post-operative atrial fibrillation in patients undergoing heart surgery. Whitlock, RP, ed. Cochrane Db Syst Rev 1:CD003611.
Borde D, et al. 2014. Prediction of postoperative atrial fibrillation after coronary artery bypass grafting surgery: is CHA 2 DS 2 -VASc score useful? Ann Cardiac Anaesth17:182-7.
da Silva RMFL. 2017. Influence of inflammation and atherosclerosis in atrial fibrillation. Current Atherosclerosis Reports 19:2.
El-Chami MF, et al. 2010. New-onset atrial fibrillation predicts long-term mortality after coronary artery bypass graft. J Am Coll Cardiol 55:1370-6.
El-Chami MF, et al. 2012. Prediction of new onset atrial fibrillation after cardiac revascularization surgery. Am J Cardiol 110:649-54.
Filardo G, et al. 2009. New-onset postoperative atrial fibrillation after isolated coronary artery bypass graft surgery and long-term survival. Circ Cardiovasc Qual Outcomes 2:164-9.
Filardo G, et al. 2016. Sex differences in the epidemiology of new-onset in-hospital post-coronary artery bypass graft surgery atrial fibrillation: a large multicenter study. Circ Cardiovasc Qual Outcomes 9:723-30.
Gang Y, et al. 2004. Preoperative electrocardiographic risk assessment of atrial fibrillation after coronary artery bypass grafting. J Cardiovasc Electrophysiol 15:1379-86.
Kalman JM, et al. 1995. Atrial fibrillation after coronary artery bypass grafting is associated with sympathetic activation. Ann Thorac Surg 60:1709-15.
Kinoshita T, et al. 2011. Preoperative C-reactive protein and atrial fibrillation after off-pump coronary bypass surgery. Eur J Cardithorac Surg 40:1298-1303.
Magne J, et al. 2017. Echocardiography is useful to predict postoperative atrial fibrillation in patients undergoing isolated coronary bypass surgery: A prospective study. Eur Heart J Acute Cardiovasc Care 17:2048872616688419.
Magruder JT, et al. 2016. Predictors of late-onset atrial fibrillation following isolated mitral valve repairs in patients with preserved ejection fraction. J Cardiac Surg 31:486-92.
Mandal K, et al. 2004. Association of anti-heat shock protein 65 antibodies with development of postoperative atrial fibrillation. Circulation 110:2588-90.
Mandal K, et al. 2005. Association of high intracellular, but not serum, heat shock protein 70 with postoperative atrial fibrillation. Ann Thorac Surg 79:865-71; discussion 871.
Mariscalco G, et al. 2014. Bedside tool for predicting the risk of postoperative atrial fibrillation after cardiac surgery: the POAF score. J Am Heart Assoc 3:e000752.
Mathew JP, et al. 2004. A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA 291:1720-9.
Melby SJ, et al. 2015. A time-related parametric risk factor analysis for postoperative atrial fibrillation after heart surgery. J Thorac Cardiovasc Surg 149:886-92.
O’Neal WT, et al. 2013. Impact of race and postoperative atrial fibrillation on long-term survival after coronary artery bypass grafting. J Cardiac Surg 28:484-91.
Osranek M, et al. 2006. Left atrial volume predicts the risk of atrial fibrillation after cardiac surgery: a prospective study. J Am Coll Cardiol 48:779-86.
Tran DTT, et al. 2015. Predicting new-onset postoperative atrial fibrillation in cardiac surgery patients. J Cardiothor Vasc An 29:1117-26.
Villareal RP, et al. 2004. Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. J Am Coll Cardiol 43:742-8.
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).