Taha Amar, Martinsson Andreas, Nielsen Susanne J, Rezk Mary, Pivodic Aldina, Gudbjartsson Tomas, Herrmann Florian Ernst Martin, Bergfeldt Lennart B, Jeppsson Anders
Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Goteborg, Sweden
Department of Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden.
Heart. 2024 Dec 13;111(1):18-26. doi: 10.1136/heartjnl-2024-324573.
New-onset postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) increases ischaemic stroke risk, yet factors influencing this risk remain unclear. We sought to identify factors associated with 1-year ischaemic stroke risk, compare the CHADS-VASc (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes, previous Stroke/transient ischaemic attack (TIA), Vascular disease, Age 65-74 years, Sex category) and ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) scores' predictive abilities for ischaemic stroke, and assess oral anticoagulation (OAC) dispensing at discharge in patients with POAF.
This nationwide cohort study used prospectively collected data from four mandatory Swedish national registries. All first-time isolated CABG patients who developed POAF during 2007-2020 were included. Multivariable logistic models were used to identify ischaemic stroke predictors and C-statistics to assess the predictive abilities of the CHADS-VASc and ATRIA scores in patients without OAC. OAC dispensing patterns were described based on stroke-associated factors.
In total, 10 435 patients with POAF were identified. Out of those not receiving OAC (n=6903), 3.1% experienced an ischaemic stroke within 1 year. Advancing age (adjusted OR (aOR) 1.86 per 10-year increase, 95% CI 1.45 to 2.38), prior ischaemic stroke (aOR 18.56, 95% CI 10.05 to 34.28 at 60 years, aOR 5.95, 95% CI 3.78 to 9.37 at 80 years, interaction p<0.001), myocardial infarction (aOR 1.55, 95% CI 1.14 to 2.10) and heart failure (aOR 1.53, 95% CI 1.06 to 2.21) were independently associated with ischaemic stroke. The area under the receiver-operating characteristic curve was 0.72 (0.69-0.76) and 0.74 (0.70-0.78) for CHADS-VASc and ATRIA, respectively (p=0.021). Altogether, 71.0% of patients with a stroke risk >2%/year, according to the CHADS-VASc score, were not discharged on OAC.
Prior ischaemic stroke, advancing age, history of heart failure and myocardial infarction were associated with 1-year ischaemic stroke risk in patients with POAF after CABG. CHADS-VASc and ATRIA scores predicted stroke risk with similar accuracy as in non-surgical atrial fibrillation cohorts. OAC dispense at discharge does not seem to reflect individual stroke risk.
冠状动脉旁路移植术（CABG）后新发的术后房颤（POAF）会增加缺血性卒中风险，但影响该风险的因素仍不明确。我们试图确定与1年缺血性卒中风险相关的因素，比较CHADS-VASc（充血性心力衰竭、高血压、年龄≥75岁、糖尿病、既往卒中/短暂性脑缺血发作（TIA）、血管疾病、年龄65 - 74岁、性别分类）和ATRIA（房颤抗凝及危险因素）评分对缺血性卒中的预测能力，并评估POAF患者出院时口服抗凝药（OAC）的处方情况。
这项全国性队列研究使用了从瑞典四个强制性国家登记处前瞻性收集的数据。纳入了2007年至2020年期间发生POAF的所有首次孤立性CABG患者。多变量逻辑模型用于确定缺血性卒中的预测因素，C统计量用于评估CHADS-VASc和ATRIA评分在未使用OAC患者中的预测能力。根据与卒中相关的因素描述了OAC的处方模式。
共识别出10435例POAF患者。在未接受OAC的患者（n = 6903）中，3.1%在1年内发生了缺血性卒中。年龄增长（每增加10岁调整后的OR（aOR）为1.86，95%CI为1.45至2.38）、既往缺血性卒中（60岁时aOR为18.56，95%CI为10.05至34.28；80岁时aOR为5.95，95%CI为3.78至9.37，交互作用p<0.001）、心肌梗死（aOR为1.55，95%CI为1.14至2.10）和心力衰竭（aOR为1.53，95%CI为1.06至2.21）与缺血性卒中独立相关。CHADS-VASc和ATRIA评分的受试者工作特征曲线下面积分别为0.72（0.69 - 0.76）和
