Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; Department of General Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
J Thorac Cardiovasc Surg. 2013 Oct;146(4):919-926.e1. doi: 10.1016/j.jtcvs.2013.03.040. Epub 2013 Apr 26.
The presence of postoperative atrial fibrillation predicts a higher short- and long-term mortality rates; however, no scoring system has been used to discriminate patients at high risk for this complication. The aim of this study was to investigate whether the CHADS2 and CHA2DS2-VASc scores are useful risk assessment tools for new-onset atrial fibrillation after cardiac surgery.
A total of 277 consecutive patients who underwent cardiac surgery were prospectively included in this risk stratification study. We calculated the CHADS2 and CHA2DS2-VASc scores from the data collected. The primary end point was the development of postoperative atrial fibrillation within 30 days after cardiac surgery.
Eighty-four (30%) of the patients had postoperative atrial fibrillation at a median of 2 days (range, 0-27 days) after cardiac surgery. The CHADS2 and CHA2DS2-VASc scores were significant predictors of postoperative atrial fibrillation in separate multivariate regression analyses. The Kaplan-Meier analysis obtained a higher postoperative atrial fibrillation rate when based on the CHADS2 and CHA2DS2-VASc scores of at least 2 than when based on scores less than 2 (both log rank, P < .001). In addition, the CHA2DS2-VASc scores could be used to further stratify the patients with CHADS2 scores of 0 or 1 into 2 groups with different postoperative atrial fibrillation rates at a cutoff value of 2 (12% vs 32%; P = .01).
CHADS2 and CHA2DS2-VASc scores were predictive of postoperative atrial fibrillation after cardiac surgery and may be helpful for identifying high-risk patients.
术后心房颤动预示着短期和长期死亡率较高；然而，尚无评分系统用于区分该并发症高危患者。本研究旨在探讨 CHADS2 和 CHA2DS2-VASc 评分是否可作为心脏手术后新发心房颤动的风险评估工具。
本前瞻性风险分层研究共纳入 277 例连续接受心脏手术的患者。我们从收集的数据中计算 CHADS2 和 CHA2DS2-VASc 评分。主要终点是心脏手术后 30 天内发生术后心房颤动。
84 例（30%）患者在心脏手术后中位数为 2 天（范围 0-27 天）时发生术后心房颤动。在单独的多变量回归分析中，CHADS2 和 CHA2DS2-VASc 评分是术后心房颤动的显著预测因子。基于 CHADS2 和 CHA2DS2-VASc 评分至少为 2 的 Kaplan-Meier 分析获得了更高的术后心房颤动发生率，而基于评分小于 2 的则更低（均对数秩，P<0.001）。此外，CHA2DS2-VASc 评分可用于将 CHADS2 评分为 0 或 1 的患者进一步分层为 2 组，分界值为 2，术后心房颤动发生率分别为 12%和 32%（P=0.01）。
CHADS2 和 CHA2DS2-VASc 评分可预测心脏手术后的术后心房颤动，有助于识别高危患者。
