A A Novel Risk Score to Predict New Onset Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Grafting
DOI:
https://doi.org/10.1532/hsf.2151Abstract
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.
References
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.
