Pollock Benjamin D, Filardo Giovanni, da Graca Briget, Phan Teresa K, Ailawadi Gorav, Thourani Vinod, Damiano Ralph J, Edgerton James R
Office of the Chief Quality Officer, Baylor Scott & White Health, Dallas, Texas.
Office of the Chief Quality Officer, Baylor Scott & White Health, Dallas, Texas; The Heart Hospital Baylor Plano, Plano, Texas.
Ann Thorac Surg. 2018 Jan;105(1):115-121. doi: 10.1016/j.athoracsur.2017.06.075. Epub 2017 Nov 7.
New-onset atrial fibrillation (AF) after coronary artery bypass graft (CABG) operation is associated with poorer survival. Blanket prophylaxis efforts have not appreciably decreased incidence, making targeted prevention for high-risk patients desirable. We compared predictive abilities of existing scores developed/used to predict adverse CABG outcomes (Society of Thoracic Surgeons' [STS] risk of mortality) or AF not associated with cardiac operation (the Cohorts for Heart and Aging Research in Genomic Epidemiology [CHARGE]-AF score, the CHADS-VASc score), and a risk model for predicting postoperative AF following cardiac operations (POAF score), with age (the most consistently identified post-CABG AF risk factor).
Data submitted to the STS Adult Cardiac Surgery Database were used to assess new-onset AF in 8,976 consecutive patients without preoperative AF undergoing isolated CABG from 2004 to 2010 at five participating centers. Five logistic regression models (for CHADS-VASc score, CHARGE-AF score, POAF score, STS risk score, and age, respectively, all modeled with restricted cubic splines) with a random effect for site were fitted to predict post-CABG AF. Estimates were used to compute and compare receiver operating characteristic (ROC) areas.
New-onset AF occurred in 2,141 patients (23.9%). The ROC area was greatest for CHARGE-AF (0.68, 95% confidence interval [CI]: 0.67-0.69), followed by age (0.66, 95% CI: 0.65-0.68), POAF score (0.65, 95% CI: 0.64-0.66), CHADS-VASc (0.59, 95% CI: 0.58 to 0.60), and STS risk of mortality (0.58, 95% CI: 0.56-0.59). CHARGE-AF was significantly more predictive than age (p < 0.0001); the other scores were significantly less predictive (p < 0.0001).
Only CHARGE-AF performed better than age alone. Its performance was moderate and comparable with published risk models specifically targeted at new-onset post-isolated CABG AF. Future research should continue to focus on developing better predictive models.
冠状动脉旁路移植术（CABG）后新发房颤（AF）与较差的生存率相关。全面预防措施并未显著降低其发生率，因此对高危患者进行针对性预防很有必要。我们比较了用于预测CABG不良结局（胸外科医师协会[STS]死亡风险）或与心脏手术无关的房颤（基因组流行病学心脏与衰老研究队列[CHARGE]-AF评分、CHADS-VASc评分）的现有评分，以及预测心脏手术后房颤（POAF评分）的风险模型与年龄（CABG后最一致确定的房颤危险因素）的预测能力。
提交至STS成人心脏手术数据库的数据用于评估2004年至2010年在五个参与中心接受单纯CABG且术前无房颤的8976例连续患者中的新发房颤情况。建立五个逻辑回归模型（分别针对CHADS-VASc评分、CHARGE-AF评分、POAF评分、STS风险评分和年龄，均采用受限立方样条建模），并纳入部位的随机效应，以预测CABG术后房颤。估计值用于计算和比较受试者工作特征（ROC）曲线下面积。
2141例患者（23.9%）发生新发房颤。CHARGE-AF的ROC曲线下面积最大（0.68，95%置信区间[CI]：0.67 - 0.69），其次是年龄（0.66，95%CI：0.65 - 0.68）、POAF评分（0.65，95%CI：0.64 - 0.66）、CHADS-VASc（0.59，95%CI：0.58至0.60）和STS死亡风险（0.58，95%CI：0.56 - 0.59）。CHARGE-AF的预测能力显著高于年龄（p < 0.0001）；其他评分的预测能力显著较低（p < 0.0001）。
只有CHARGE-AF的表现优于单独的年龄。其性能中等，与专门针对单纯CABG术后新发房颤的已发表风险模型相当。未来的研究应继续专注于开发更好的预测模型。
