Mortazavi Seyedeh Hamideh, Oraii Alireza, Goodarzynejad Hamidreza, Bina Peyvand, Jalali Arash, Ahmadi Tafti Seyed Hossein, Bagheri Jamshid, Sadeghian Saeed
Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
J Cardiothorac Vasc Anesth. 2022 May;36(5):1304-1309. doi: 10.1053/j.jvca.2021.07.028. Epub 2021 Jul 18.
The authors aimed to investigate the role of CHADS-VASc score and its components in prediction of postoperative atrial fibrillation (POAF) after isolated coronary artery bypass graft (CABG) surgery.
Retrospective cohort.
Single-center university-affiliated tertiary cardiac center.
A total of 2,981 consecutive patients who underwent isolated CABG between 2010 and 2012 were included.
All patients underwent isolated CABG and were followed until discharge or in-hospital death. The primary outcome was the development of new-onset POAF during the hospital course.
During hospitalization, continuous electrocardiogram monitoring was used to detect POAF episodes. New-onset POAF developed in 15.8% of patients following isolated CABG. Patients with POAF had significantly higher CHADS-VASc scores than those without POAF (2.66 ± 1.51 v 2.12 ± 1.36, p < 0.001). After adjustment for potential confounders, CHADS-VASc score was significantly associated with POAF (odds ratio [OR]: 1.295, 95% CI: 1.205-1.391). However, further analyses showed that this effect was restricted to patients with a CHADS-VASc score of ≥2 (OR: 1.813, 95% CI: 1.220-2.694). In multivariate analysis of the CHADS-VASc components, age ≥75 (OR: 3.737, 95% CI: 2.702-5.168), age 65 to 74 (OR: 2.126, 1.701-2.658), hypertension (OR: 1.310, 95% CI: 1.051-1.633), and cerebrovascular accident (OR: 1.807, 95% CI: 1.197-2.726) were independent predictors of POAF. However, the association between POAF and female sex, diabetes mellitus, congestive heart failure, and vascular disease was not statistically significant.
CHADS-VASc score is a useful tool for the prediction of POAF after isolated CABG. However, the risk should be interpreted cautiously, since the risk score's promising effect relies on only several of its components.
作者旨在研究CHADS-VASc评分及其各组成部分在预测单纯冠状动脉旁路移植术（CABG）术后房颤（POAF）中的作用。
回顾性队列研究。
单中心大学附属三级心脏中心。
纳入2010年至2012年间连续接受单纯CABG手术的2981例患者。
所有患者均接受单纯CABG手术，并随访至出院或院内死亡。主要结局是住院期间新发POAF。
住院期间，采用连续心电图监测以检测POAF发作。单纯CABG术后15.8%的患者发生新发POAF。发生POAF的患者CHADS-VASc评分显著高于未发生POAF的患者（2.66±1.51对2.12±1.36，p<0.001）。在对潜在混杂因素进行校正后，CHADS-VASc评分与POAF显著相关（比值比[OR]：1.295，95%可信区间[CI]：1.205-1.391）。然而，进一步分析表明，这种效应仅限于CHADS-VASc评分≥2的患者（OR：1.813，95%CI：1.220-2.694）。在对CHADS-VASc各组成部分进行多变量分析时，年龄≥75岁（OR：3.737，95%CI：2.702-5.168）、年龄65至74岁（OR：2.126，1.701-2.658）、高血压（OR：1.310，95%CI：1.051-1.633）和脑血管意外（OR：1.807，95%CI：1.197-2.726）是POAF的独立预测因素。然而，POAF与女性、糖尿病、充血性心力衰竭和血管疾病之间的关联无统计学意义。
CHADS-VASc评分是预测单纯CABG术后POAF的有用工具。然而，应谨慎解读该风险，因为风险评分的显著效应仅依赖于其几个组成部分。
