Department of Cardiology, the 2nd Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Biostatistics & Bioinformatics Shared Resource at Winship Cancer Institute, Emory University, Atlanta, Georgia; Department of Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Ann Thorac Surg. 2020 Apr;109(4):1210-1216. doi: 10.1016/j.athoracsur.2019.07.084. Epub 2019 Sep 12.
Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery, resulting in an increased risk of morbidity and longer hospital stay. Pharmacologic prophylaxis has been recommended to improve the outcome in patients at high risk of developing POAF after cardiac surgery. Several studies have applied the CHADS-VASc (Congestive heart failure, Hypertension Age [≥65 = 1 point, ≥75 = 2 points], Diabetes, and Stroke/transient ischemic attack (2 points)-vascular disease [peripheral arterial disease, previous myocardial infarction, aortic atheroma]) score in the risk stratification of POAF but yielded contradicting results. This study aims to determine the association between CHADS-VASc score and POAF and further to explore its discriminative ability for the prediction of POAF.
We systematically searched the Medline, Embase, Cochrane library, and other data sources with key terms "CHADS-VASc," "atrial fibrillation," and "cardiac surgery." Studies designed for CHADS-VASc score in stratifying the risks of POAF in patients undergoing cardiac surgery were included. Statistical analyses were performed with R 3.5.1 and STATA 13.0.
Seven hundred twenty-one studies were identified, of which 12 studies with 18,086 patients were finally included in our analysis. The CHADS-VASc score was found to be an independent predictor of POAF after cardiac surgery (odds ratio, 1.46; 95% confidence interval [CI], 1.25-1.72) and exhibited a relatively strong specificity (0.70; 95% CI, 0.61-0.78) and sensitivity (0.72; 95% CI, 0.54-0.85) for predicting POAF. The bivariate model-based pooled area under the receiver operating curve was estimated to be 0.76 (95% CI, 0.72-0.79).
The CHADS-VASc score has relatively good performance in predicting POAF after cardiac surgery and may help identify the patients at high risk of POAF.
术后心房颤动（POAF）是心脏手术后的常见并发症，会增加发病率和住院时间延长的风险。药物预防已被推荐用于改善心脏手术后发生 POAF 风险较高的患者的结局。几项研究已将 CHADS-VASc（充血性心力衰竭、高血压（年龄≥65=1 分，≥75=2 分）、糖尿病和中风/短暂性脑缺血发作（2 分）-血管疾病[外周动脉疾病、既往心肌梗死、主动脉粥样硬化]）评分应用于 POAF 的风险分层，但结果相互矛盾。本研究旨在确定 CHADS-VASc 评分与 POAF 的关系，并进一步探讨其预测 POAF 的区分能力。
我们系统地检索了 Medline、Embase、Cochrane 图书馆和其他数据源，使用的关键词是“CHADS-VASc”、“心房颤动”和“心脏手术”。纳入设计用于心脏手术后根据 CHADS-VASc 评分分层 POAF 风险的研究。使用 R 3.5.1 和 STATA 13.0 进行统计分析。
共确定了 721 项研究，其中最终纳入了 12 项研究，共 18086 例患者。CHADS-VASc 评分是心脏手术后 POAF 的独立预测因子（优势比，1.46；95%置信区间[CI]，1.25-1.72），并具有相对较强的特异性（0.70；95%CI，0.61-0.78）和敏感性（0.72；95%CI，0.54-0.85）预测 POAF。基于双变量模型的受试者工作特征曲线下面积估计为 0.76（95%CI，0.72-0.79）。
CHADS-VASc 评分在预测心脏手术后 POAF 方面具有较好的性能，可能有助于识别 POAF 风险较高的患者。
