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主动脉瓣置换术后心房颤动预测模型

Atrial Fibrillation Prediction Model Following Aortic Valve Replacement Surgery.

作者信息

Knez Nora, Kopjar Tomislav, Tokic Tomislav, Gasparovic Hrvoje

机构信息

Institute of Emergency Medicine of the City of Zagreb, 10000 Zagreb, Croatia.

Department of Cardiac Surgery, University Hospital Center Zagreb, 10000 Zagreb, Croatia.

出版信息

J Cardiovasc Dev Dis. 2025 Jan 31;12(2):52. doi: 10.3390/jcdd12020052.

Abstract

(1) Background: Postoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery. It leads to increased perioperative morbidity and costs. Our study aimed to determine the incidence of new-onset POAF in patients undergoing isolated aortic valve replacement (AVR) and develop a multivariate model to identify its predictors. (2) Methods: We conducted a retrospective study including all consecutive patients who underwent isolated AVR at our institution between January 2010 and December 2022. Patients younger than 18, with a history of atrial fibrillation, previous cardiac surgery, or those who underwent concomitant procedures were excluded. Patients were dichotomized into POAF and No POAF groups. Multivariate logistic regression with backward elimination was utilized for predictive modeling. (3) Results: This study included 1108 patients, of which 297 (27%) developed POAF. The final multivariate model identified age, larger valve size, cardiopulmonary bypass time, delayed sternal closure, ventilation time, and intensive care unit stay as predictors of POAF. The model exhibited fair predictive ability (AUC = 0.678, < 0.001), with the Hosmer-Lemeshow test confirming good model fit ( = 0.655). The overall correct classification percentage was 65.6%. (4) Conclusions: A POAF prediction model offers personalized risk estimates, allowing for tailored management strategies with the potential to enhance patient outcomes and optimize healthcare costs.

摘要

(1) 背景:术后心房颤动(POAF)是心脏手术后最常见的并发症。它会导致围手术期发病率增加和成本上升。我们的研究旨在确定接受单纯主动脉瓣置换术(AVR)患者中新发POAF的发生率,并建立一个多变量模型来识别其预测因素。(2) 方法:我们进行了一项回顾性研究,纳入了2010年1月至2022年12月期间在我们机构接受单纯AVR的所有连续患者。排除年龄小于18岁、有心房颤动病史、既往心脏手术史或接受同期手术的患者。患者被分为POAF组和非POAF组。采用向后逐步淘汰的多变量逻辑回归进行预测建模。(3) 结果:本研究纳入1108例患者,其中297例(27%)发生POAF。最终的多变量模型确定年龄、瓣膜尺寸较大、体外循环时间、延迟胸骨闭合、通气时间和重症监护病房停留时间为POAF的预测因素。该模型具有中等预测能力(AUC = 0.678,P < 0.001),Hosmer-Lemeshow检验证实模型拟合良好(P = 0.655)。总体正确分类百分比为65.6%。(4) 结论:POAF预测模型提供个性化风险评估,有助于制定量身定制的管理策略,有可能改善患者预后并优化医疗成本。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f44/11856475/148a907eae04/jcdd-12-00052-g001.jpg

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