Departments of Anesthesiology (M.D.K.), Vanderbilt University Medical Center, Nashville, TN.
Medicine (J.D.M., D.M.R.), Vanderbilt University Medical Center, Nashville, TN.
Circ Genom Precis Med. 2021 Apr;14(2):e003269. doi: 10.1161/CIRCGEN.120.003269. Epub 2021 Mar 1.
Postoperative atrial fibrillation (PoAF) remains a significant risk factor for increased morbidity and mortality after cardiac surgery. The ability to accurately identify patients at risk through clinical risk factors is limited. There is growing evidence that polygenic risk contributes significantly to PoAF and incorporating measures of genetic risk could enhance prediction.
A retrospective cohort study of 1047 patients of White European ancestry who underwent either coronary artery bypass grafting or valve surgery at a tertiary academic center and were free from a history or persistent preoperative atrial fibrillation. The primary outcome was defined as PoAF based on postoperative ECG reports, medical record documentation, and changes in medication. The exposure was a polygenic risk score (PRS) comprising 2746 single-nucleotide polymorphisms previously associated with atrial fibrillation risk. The prediction of PoAF risk was assessed using measures of model discrimination, calibration, and net reclassification improvement.
A total of 259 patients (24.7%) developed PoAF. The PRS was significantly associated with a higher risk for PoAF (odds ratio, 1.63 per SD increase in PRS [95% CI, 1.41-1.90]). Addition of PRS to patient- and procedure-related predictors of PoAF significantly increased the C statistic from 0.742 to 0.782 (change in C statistic, 0.040 [95% CI, 0.021-0.060]) while maintaining good calibration. The addition of the PRS to patient- and procedure-related predictors of PoAF improved model fit (likelihood ratio test, =2.8×10) and significantly improved measures of reclassification (net reclassification improvement, 0.158 [95% CI, 0.066-0.274]).
The PRS for PoAF was associated with improved discrimination, calibration, and risk reclassification compared with conventional clinical predictors suggesting that a PoAF PRS may enhance risk prediction of PoAF in patients undergoing coronary artery bypass grafting or valve surgery.
术后心房颤动（PoAF）仍然是心脏手术后发病率和死亡率增加的一个重要危险因素。通过临床危险因素准确识别高危患者的能力有限。越来越多的证据表明，多基因风险对 PoAF 有重要贡献，纳入遗传风险因素可以提高预测能力。
这是一项对 1047 名白人欧洲血统患者的回顾性队列研究，这些患者在一家三级学术中心接受了冠状动脉旁路移植术或瓣膜手术，且术前无房颤病史或持续性房颤。主要结局定义为术后心电图报告、病历记录和药物治疗改变所确定的 PoAF。暴露因素是一个多基因风险评分（PRS），包含 2746 个与房颤风险相关的单核苷酸多态性。PoAF 风险预测采用模型区分度、校准度和净重新分类改善的指标进行评估。
共有 259 例患者（24.7%）发生了 PoAF。PRS 与 PoAF 风险升高显著相关（比值比，PRS 每增加 1 个标准差，PoAF 风险增加 1.63[95%CI，1.41-1.90]）。在 PoAF 的患者和手术相关预测因素中加入 PRS，可将 C 统计量从 0.742 提高到 0.782（C 统计量的变化，0.040[95%CI，0.021-0.060]），同时保持良好的校准度。在 PoAF 的患者和手术相关预测因素中加入 PRS 可改善模型拟合（似然比检验，=2.8×10），并显著改善重新分类的各项指标（净重新分类改善，0.158[95%CI，0.066-0.274]）。
与传统临床预测因素相比，PoAF 的 PRS 与更好的区分度、校准度和风险重新分类相关，提示 PoAF PRS 可能增强接受冠状动脉旁路移植术或瓣膜手术患者的 PoAF 风险预测。
