Potdar Shreyas Prakash, Shales Sufina, Baviskar Mandar, Sharma Manish, Kapoor Lalit, Narayan Pradeep
Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, Kolkata, India.
Pravara Institute of Medical Sciences, Loni, Maharashtra India.
Indian J Thorac Cardiovasc Surg. 2022 Jul;38(4):366-374. doi: 10.1007/s12055-022-01358-7. Epub 2022 May 11.
Indian patients who undergo surgical revascularization are relatively younger than their Western counterparts and are predominantly revascularized using off-pump coronary artery bypass grafting (OPCAB) technique. They may therefore be at a reduced risk of developing post-operative atrial fibrillation (POAF). The aim of this study was to assess the incidence of POAF, measure its impact on outcomes, and identify the predictors for POAF in the Indian patients undergoing OPCAB. Besides, the ability of European System for Cardiac Operative Risk Evaluation (EuroSCORE) and Society of Thoracic Surgeons (STS) scores in predicting POAF was also assessed.
In this prospective observational study, all patients undergoing isolated OPCAB in a single institution over a 12-month period were included. Patients undergoing re-operative surgery, emergency procedure, concomitant surgery, or those with history of previously diagnosed or treated atrial fibrillation were excluded. Logistic regression was performed to identify the predictors of POAF. The receiver operating characteristic (ROC) curve was used to determine the ability of EuroSCORE and STS scores to assess risk of developing POAF.
We recruited 1108 patients in the study of which 88 (7.94%) patients developed POAF. Age (OR = 1.082, < 0.001, 95%CI: 1.050-1.114), unstable angina (OR = 16.32, = 0.036, 95%CI: 1.2-221.4), presence of diabetes mellitus (OR 1.781, = 0.025, 95%CI: 1.074-2.955), left atrial size (OR 2.506, = 0.001, 95%CI: 1.478-4.251), and presence of chronic renal failure (OR 8.7, = 0.001, 95%CI: 2.4-31.53) were significant predictors of POAF. Both the EuroSCORE ( = 0.035) and the STS score ( = 0.001) were significantly higher in patients developing POAF. The area under the ROC curve for the EuroSCORE II was 0.62 and for the STS score was 0.64 suggesting satisfactory and similar discriminatory power of both the scores to predict POAF in these patients. POAF was associated with significantly increased adverse outcomes like stroke and prolonged hospital stay.
In our study, the incidence of POAF was much lower (7.94%) than that reported previously. POAF significantly increased adverse outcomes and length of hospital stay. Both EuroSCORE II and STS scores had similar discriminating power in predicting POAF.
接受外科血管重建术的印度患者相对比西方患者年轻，且主要采用非体外循环冠状动脉搭桥术（OPCAB）进行血管重建。因此，他们发生术后房颤（POAF）的风险可能较低。本研究的目的是评估POAF的发生率，衡量其对预后的影响，并确定接受OPCAB的印度患者发生POAF的预测因素。此外，还评估了欧洲心脏手术风险评估系统（EuroSCORE）和胸外科医师协会（STS）评分预测POAF的能力。
在这项前瞻性观察性研究中，纳入了在12个月期间内于单一机构接受单纯OPCAB的所有患者。排除接受再次手术、急诊手术、同期手术的患者，或有先前诊断或治疗过房颤病史的患者。进行逻辑回归分析以确定POAF的预测因素。采用受试者工作特征（ROC）曲线来确定EuroSCORE和STS评分评估发生POAF风险的能力。
我们在研究中招募了1108例患者，其中88例（7.94%）发生了POAF。年龄（OR = 1.082，P < 0.001，95%CI：1.050 - 1.114）、不稳定型心绞痛（OR = 16.32，P = 0.036，95%CI：1.2 - 221.4）、糖尿病的存在（OR 1.781，P = 0.025，95%CI：1.074 - 2.955）、左心房大小（OR 2.506，P = 0.001，95%CI：1.478 - 4.251）以及慢性肾衰竭的存在（OR 8.7，P = 0.001，95%CI：2.4 - 31.53）是POAF的显著预测因素。发生POAF的患者EuroSCORE（P = 0.035）和STS评分（P = 0.001）均显著更高。EuroSCORE II的ROC曲线下面积为0.62，STS评分的ROC曲线下面积为0.64，表明这两种评分在预测这些患者的POAF方面具有相似且令人满意的鉴别能力。POAF与中风和住院时间延长等不良结局显著增加相关。
在我们的研究中，POAF的发生率（7.94%）远低于先前报道的发生率。POAF显著增加了不良结局和住院时间。EuroSCORE II和STS评分在预测POAF方面具有相似的鉴别能力。
