A A Novel Risk Score to Predict New Onset Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Grafting

Sophie Z. Lin, Todd C. Crawford, Alejandro Suarez-Pierre, J. Trent Magruder, Michael V. Carter, Duke E. Cameron, Glenn J. Whitman, Jennifer Lawton, William A. Baumgartner, Kaushik Mandal

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Atrial fibrillation (AF) is common after cardiac surgery and contributes to increased morbidity and mortality. Our objective was to derive and validate a predictive model for AF after CABG in patients, incorporating novel echocardiographic and laboratory values. METHODS: We retrospectively reviewed patients at our institution without preexisting dysrhythmia who underwent on-pump, isolated CABG from 2011-2015. The primary outcome was new onset AF lasting >1 hour on continuous telemetry or requiring medical treatment. Patients with a preoperative echocardiographic measurement of left atrial diameter were included in a risk model, and were randomly divided into derivation (80%) and validation (20%) cohorts. The predictors of AF after CABG (PAFAC) score was derived from a multivariable logistic regression model by multiplying the adjusted odds ratios of significant risk factors (P < .05) by a factor of 4 to derive an integer point system. RESULTS: 1307 patients underwent isolated CABG, including 762/1307 patients with a preoperative left atrial diameter measurement. 209/762 patients (27%) developed new onset AF including 165/611 (27%) in the derivation cohort. We identified four risk factors independently associated with postoperative AF which comprised the PAFAC score: age > 60 years (5 points), White race (5 points), baseline GFR < 90 mL/min (4 points) and left atrial diameter > 4.5 cm (4 points). Scores ranged from 0-18. The PAFAC score was then applied to the validation cohort and predicted incidence of AF strongly correlated with observed incidence (r = 0.92). CONCLUSION: The PAFAC score is easy to calculate and can be used upon ICU admission to reliably identify patients at high risk of developing AF after isolated CABG.

Original languageEnglish (US)
Pages (from-to)E489-E496
JournalThe heart surgery forum
Volume21
Issue number6
DOIs
StatePublished - Dec 13 2018

Fingerprint

Coronary Artery Bypass
Atrial Fibrillation
Logistic Models
Telemetry
Incidence
Thoracic Surgery
Odds Ratio
Morbidity
Mortality

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Lin, S. Z., Crawford, T. C., Suarez-Pierre, A., Magruder, J. T., Carter, M. V., Cameron, D. E., ... Mandal, K. (2018). A A Novel Risk Score to Predict New Onset Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Grafting. The heart surgery forum, 21(6), E489-E496. https://doi.org/10.1532/hsf.2151

A A Novel Risk Score to Predict New Onset Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Grafting. / Lin, Sophie Z.; Crawford, Todd C.; Suarez-Pierre, Alejandro; Magruder, J. Trent; Carter, Michael V.; Cameron, Duke E.; Whitman, Glenn J.; Lawton, Jennifer; Baumgartner, William A.; Mandal, Kaushik.

In: The heart surgery forum, Vol. 21, No. 6, 13.12.2018, p. E489-E496.

Research output: Contribution to journalArticle

Lin, Sophie Z. ; Crawford, Todd C. ; Suarez-Pierre, Alejandro ; Magruder, J. Trent ; Carter, Michael V. ; Cameron, Duke E. ; Whitman, Glenn J. ; Lawton, Jennifer ; Baumgartner, William A. ; Mandal, Kaushik. / A A Novel Risk Score to Predict New Onset Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Grafting. In: The heart surgery forum. 2018 ; Vol. 21, No. 6. pp. E489-E496.
@article{40f223364391472bb04f173d04ef22ea,
title = "A A Novel Risk Score to Predict New Onset Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Grafting",
abstract = "BACKGROUND: Atrial fibrillation (AF) is common after cardiac surgery and contributes to increased morbidity and mortality. Our objective was to derive and validate a predictive model for AF after CABG in patients, incorporating novel echocardiographic and laboratory values. METHODS: We retrospectively reviewed patients at our institution without preexisting dysrhythmia who underwent on-pump, isolated CABG from 2011-2015. The primary outcome was new onset AF lasting >1 hour on continuous telemetry or requiring medical treatment. Patients with a preoperative echocardiographic measurement of left atrial diameter were included in a risk model, and were randomly divided into derivation (80{\%}) and validation (20{\%}) cohorts. The predictors of AF after CABG (PAFAC) score was derived from a multivariable logistic regression model by multiplying the adjusted odds ratios of significant risk factors (P < .05) by a factor of 4 to derive an integer point system. RESULTS: 1307 patients underwent isolated CABG, including 762/1307 patients with a preoperative left atrial diameter measurement. 209/762 patients (27{\%}) developed new onset AF including 165/611 (27{\%}) in the derivation cohort. We identified four risk factors independently associated with postoperative AF which comprised the PAFAC score: age > 60 years (5 points), White race (5 points), baseline GFR < 90 mL/min (4 points) and left atrial diameter > 4.5 cm (4 points). Scores ranged from 0-18. The PAFAC score was then applied to the validation cohort and predicted incidence of AF strongly correlated with observed incidence (r = 0.92). CONCLUSION: The PAFAC score is easy to calculate and can be used upon ICU admission to reliably identify patients at high risk of developing AF after isolated CABG.",
author = "Lin, {Sophie Z.} and Crawford, {Todd C.} and Alejandro Suarez-Pierre and Magruder, {J. Trent} and Carter, {Michael V.} and Cameron, {Duke E.} and Whitman, {Glenn J.} and Jennifer Lawton and Baumgartner, {William A.} and Kaushik Mandal",
year = "2018",
month = "12",
day = "13",
doi = "10.1532/hsf.2151",
language = "English (US)",
volume = "21",
pages = "E489--E496",
journal = "Heart Surgery Forum",
issn = "1098-3511",
publisher = "Carden Jennings Publishing Co. Ltd",
number = "6",

}

TY - JOUR

T1 - A A Novel Risk Score to Predict New Onset Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Grafting

AU - Lin, Sophie Z.

AU - Crawford, Todd C.

AU - Suarez-Pierre, Alejandro

AU - Magruder, J. Trent

AU - Carter, Michael V.

AU - Cameron, Duke E.

AU - Whitman, Glenn J.

AU - Lawton, Jennifer

AU - Baumgartner, William A.

AU - Mandal, Kaushik

PY - 2018/12/13

Y1 - 2018/12/13

N2 - BACKGROUND: Atrial fibrillation (AF) is common after cardiac surgery and contributes to increased morbidity and mortality. Our objective was to derive and validate a predictive model for AF after CABG in patients, incorporating novel echocardiographic and laboratory values. METHODS: We retrospectively reviewed patients at our institution without preexisting dysrhythmia who underwent on-pump, isolated CABG from 2011-2015. The primary outcome was new onset AF lasting >1 hour on continuous telemetry or requiring medical treatment. Patients with a preoperative echocardiographic measurement of left atrial diameter were included in a risk model, and were randomly divided into derivation (80%) and validation (20%) cohorts. The predictors of AF after CABG (PAFAC) score was derived from a multivariable logistic regression model by multiplying the adjusted odds ratios of significant risk factors (P < .05) by a factor of 4 to derive an integer point system. RESULTS: 1307 patients underwent isolated CABG, including 762/1307 patients with a preoperative left atrial diameter measurement. 209/762 patients (27%) developed new onset AF including 165/611 (27%) in the derivation cohort. We identified four risk factors independently associated with postoperative AF which comprised the PAFAC score: age > 60 years (5 points), White race (5 points), baseline GFR < 90 mL/min (4 points) and left atrial diameter > 4.5 cm (4 points). Scores ranged from 0-18. The PAFAC score was then applied to the validation cohort and predicted incidence of AF strongly correlated with observed incidence (r = 0.92). CONCLUSION: The PAFAC score is easy to calculate and can be used upon ICU admission to reliably identify patients at high risk of developing AF after isolated CABG.

AB - BACKGROUND: Atrial fibrillation (AF) is common after cardiac surgery and contributes to increased morbidity and mortality. Our objective was to derive and validate a predictive model for AF after CABG in patients, incorporating novel echocardiographic and laboratory values. METHODS: We retrospectively reviewed patients at our institution without preexisting dysrhythmia who underwent on-pump, isolated CABG from 2011-2015. The primary outcome was new onset AF lasting >1 hour on continuous telemetry or requiring medical treatment. Patients with a preoperative echocardiographic measurement of left atrial diameter were included in a risk model, and were randomly divided into derivation (80%) and validation (20%) cohorts. The predictors of AF after CABG (PAFAC) score was derived from a multivariable logistic regression model by multiplying the adjusted odds ratios of significant risk factors (P < .05) by a factor of 4 to derive an integer point system. RESULTS: 1307 patients underwent isolated CABG, including 762/1307 patients with a preoperative left atrial diameter measurement. 209/762 patients (27%) developed new onset AF including 165/611 (27%) in the derivation cohort. We identified four risk factors independently associated with postoperative AF which comprised the PAFAC score: age > 60 years (5 points), White race (5 points), baseline GFR < 90 mL/min (4 points) and left atrial diameter > 4.5 cm (4 points). Scores ranged from 0-18. The PAFAC score was then applied to the validation cohort and predicted incidence of AF strongly correlated with observed incidence (r = 0.92). CONCLUSION: The PAFAC score is easy to calculate and can be used upon ICU admission to reliably identify patients at high risk of developing AF after isolated CABG.

UR - http://www.scopus.com/inward/record.url?scp=85059497373&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85059497373&partnerID=8YFLogxK

U2 - 10.1532/hsf.2151

DO - 10.1532/hsf.2151

M3 - Article

C2 - 30604674

AN - SCOPUS:85059497373

VL - 21

SP - E489-E496

JO - Heart Surgery Forum

JF - Heart Surgery Forum

SN - 1098-3511

IS - 6

ER -