Kashani Rustin G, Sareh Sohail, Genovese Bradley, Hershey Christina, Rezentes Corrine, Shemin Richard, Buch Eric, Benharash Peyman
Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
J Surg Res. 2015 Oct;198(2):267-72. doi: 10.1016/j.jss.2015.04.047. Epub 2015 Apr 18.
Postoperative atrial fibrillation (POAF) is the most frequent complication of cardiac surgery and is associated with increased morbidity and mortality. Pharmacologic prophylaxis is the main method of preventing POAF but needs to be targeted to patients at high risk of developing POAF. The CHA2DS2-VASc scoring system is a clinical guideline for assessing ischemic stroke risk in patients with atrial fibrillation. The present study evaluated the utility of this scoring system in predicting the risk of developing de novo POAF in cardiac surgery patients.
A total of 2385 patients undergoing cardiac surgery at our institution from 2008-2014 were identified for analysis. Each patient was assigned a CHA2DS2-VASc score and placed into a low- (score of 0), intermediate- (1), or high-risk (≥2) group. A multivariate regression model was created to control for known risk factors of atrial fibrillation.
POAF occurred in 380 of 2385 patients (15.9%). Mean CHA2DS2-VASc scores among patients with POAF and without POAF were 3.6 ± 1.7 and 2.8 ± 1.7, respectively (P < 0.0001). Using multivariate analysis, as a patient's CHA2DS2-VASc score rose from 0-9, the risk of developing POAF increased from 8.2%-42.3%. Each point increase was associated with higher odds of developing POAF (adjusted odds ratio, 1.27; 95% confidence interval, 1.18-1.36, P < 0.0001). Compared with low-risk patients, patients in the high-risk group were 5.21 times more likely to develop POAF (P < 0.0001).
The CHA2DS2-VASc algorithm is a simple risk-stratification tool that could be used to direct pharmacologic prophylaxis toward patients most likely to experience POAF.
术后心房颤动（POAF）是心脏手术最常见的并发症，与发病率和死亡率增加相关。药物预防是预防POAF的主要方法，但需要针对发生POAF高风险的患者。CHA2DS2-VASc评分系统是评估心房颤动患者缺血性卒中风险的临床指南。本研究评估了该评分系统在预测心脏手术患者发生新发POAF风险中的效用。
确定2008年至2014年在本机构接受心脏手术的2385例患者进行分析。为每位患者分配CHA2DS2-VASc评分，并分为低风险（评分为0）、中度风险（1）或高风险（≥2）组。创建多变量回归模型以控制心房颤动的已知风险因素。
2385例患者中有380例发生POAF（15.9%）。发生POAF和未发生POAF患者的平均CHA2DS2-VASc评分分别为3.6±1.7和2.8±1.7（P<0.0001）。使用多变量分析，随着患者的CHA2DS2-VASc评分从0增加到9，发生POAF的风险从8.2%增加到42.3%。每增加1分与发生POAF的更高几率相关（调整后的优势比为1.27；95%置信区间为1.18-1.36，P<0.0001）。与低风险患者相比，高风险组患者发生POAF的可能性高5.21倍（P<0.0001）。
CHA2DS2-VASc算法是一种简单的风险分层工具，可用于指导对最有可能发生POAF的患者进行药物预防。
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