Tran DTT, Perry JJ, Dupuis JY, Elmestekawy E, Wells GA. Predicting New-Onset Postoperative Atrial Fibrillation in Cardiac Surgery Patients.
J Cardiothorac Vasc Anesth 2014;
29:1117-26. [PMID:
25857671 DOI:
10.1053/j.jvca.2014.12.012]
[Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Indexed: 01/15/2023]
Abstract
OBJECTIVE
To derive a simple clinical prediction rule identifying patients at high risk of developing new-onset postoperative atrial fibrillation (POAF) after cardiac surgery.
DESIGN
Retrospective analysis on prospectively collected observational data.
SETTING
A university-affiliated cardiac hospital.
PARTICIPANTS
Adult patients undergoing coronary artery bypass grafting and/or valve surgery.
INTERVENTIONS
Observation for the occurrence of new-onset postoperative atrial fibrillation.
MEASUREMENTS AND MAIN RESULTS
Details on 28 preoperative variables from 999 patients were collected and significant predictors (p<0.2) were inserted into multivariable logistic regression and reconfirmed with recursive partitioning. A total of 305 (30.5%) patients developed new-onset POAF. Eleven variables were associated significantly with atrial fibrillation. A multivariable logistic regression model included left atrial dilatation, mitral valve disease, and age. Coefficients from the model were converted into a simple 7-point predictive score. The risk of POAF per score is: 15.0%, if 0; 20%, if 1; 27%, if 2; 35%, if 3; 44%, if 4; 53%, if 5; 62%, if 6; and 70%, if 7. A score of 4 has a sensitivity of 44% and a specificity of 82% for POAF. A score of 6 has a sensitivity of 11% and a specificity of 97%. Bootstrapping with 5,000 samples confirmed the final model provided consistent predictions.
CONCLUSIONS
This study proposed a simple predictive score incorporating three risk variables to identify cardiac surgical patients at high risk of developing new-onset POAF. Preventive treatment should target patients ≥ 65 years with left atrial dilatation and mitral valve disease.
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