A A Novel Risk Score to Predict New Onset Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Grafting

Authors

  • Sophie Z Lin Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  • Todd C Crawford Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  • Alejandro Suarez-Pierre Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  • J Trent Magruder Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  • Michael V Carter Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  • Duke E Cameron Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  • Glenn J Whitman Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  • Jennifer Lawton Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  • William A Baumgartner Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  • Kaushik Mandal Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

DOI:

https://doi.org/10.1532/hsf.2151

Abstract

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.

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Published

2018-12-13

How to Cite

Lin, S. Z., Crawford, T. C., Suarez-Pierre, A., Magruder, J. T., Carter, M. V., Cameron, D. E., Whitman, G. J., Lawton, J., Baumgartner, W. A., & Mandal, K. (2018). A A Novel Risk Score to Predict New Onset Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Grafting. The Heart Surgery Forum, 21(6), E489-E496. https://doi.org/10.1532/hsf.2151

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