Department of Anesthesiology, Duke University Medical Centre, Durham, NC, USA.
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
Can J Anaesth. 2018 Jul;65(7):786-796. doi: 10.1007/s12630-018-1119-x. Epub 2018 Apr 11.
The Multicenter Study of Perioperative Ischemia (McSPI) AFRisk index predicts postoperative atrial fibrillation (POAF) after cardiac surgery, but requires pre-, intra-, and postoperative data. Other more abbreviated risk indices exist, but there is no consensus on which risk index is optimal. We compared the discriminatory capacity of the McSPI AFRisk index with three indices containing only preoperative data (the CHADSVasc score, POAF score, and Kolek clinical risk prediction model), hypothesizing that the McSPI AFRisk index would have superior predictive capacity.
We retrospectively evaluated 783 patients undergoing cardiac surgery using cardiopulmonary bypass. The predictive capacity of each index was assessed by comparing receiver-operating characteristic (ROC) curves, scaled Brier scores, net reclassification indices, and the integrated discrimination indices.
The incidence of POAF was 32.6%. The area under the curve (AUC) of the ROC curve were 0.77, 0.58, 0.66, and 0.66 for the McSPI AFRisk index, CHADSVasc score, POAF score, and Kolek clinical risk prediction model, respectively. The McSPI AFRIsk index had the highest AUC (P < 0.0001). The scaled Brier scores for the McSPI AFRisk index, CHADSVasc score, POAF score, and Kolek clinical risk prediction model were 0.23, 0.02, 0.08, and 0.07, respectively. Both net reclassification indices and integrated discrimination indices showed that the McSPI AFRisk index more appropriately identified patients at high risk of POAF.
The McSPI AFRisk index showed superior ability to predict POAF after cardiac surgery compared with three other indices. When clinicians and investigators wish to measure the risk of POAF after cardiac surgery, they should consider using the McSPI AFRisk index.
多中心围手术期缺血研究（McSPI）AFRisk 指数可预测心脏手术后心房颤动（POAF），但需要术前、术中及术后数据。其他更简短的风险指数存在，但哪种风险指数是最佳的尚无共识。我们比较了 McSPI AFRisk 指数与仅包含术前数据的三个指数（CHADSVasc 评分、POAF 评分和 Kolek 临床风险预测模型）的鉴别能力，假设 McSPI AFRisk 指数具有更好的预测能力。
我们回顾性评估了 783 例接受体外循环心脏手术的患者。通过比较接受者操作特征（ROC）曲线、比例 Brier 评分、净重新分类指数和综合鉴别指数来评估每个指数的预测能力。
POAF 的发生率为 32.6%。ROC 曲线下面积（AUC）分别为 0.77、0.58、0.66 和 0.66，用于 McSPI AFRisk 指数、CHADSVasc 评分、POAF 评分和 Kolek 临床风险预测模型。McSPI AFRisk 指数的 AUC 最高（P<0.0001）。McSPI AFRisk 指数、CHADSVasc 评分、POAF 评分和 Kolek 临床风险预测模型的比例 Brier 评分分别为 0.23、0.02、0.08 和 0.07。净重新分类指数和综合鉴别指数均表明，McSPI AFRisk 指数更能恰当地识别 POAF 风险较高的患者。
与其他三个指数相比，McSPI AFRisk 指数在预测心脏手术后 POAF 方面具有更好的能力。当临床医生和研究人员希望测量心脏手术后 POAF 的风险时，他们应该考虑使用 McSPI AFRisk 指数。
