Older age is the strongest predictor of postoperative atrial fibrillation
Older age is the strongest predictor of postoperative atrial fibrillation
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DOI：
10.1097/00000542-200202000-00021
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发表时间：
2002-02-01
期刊：
影响因子：
8.8
通讯作者：
Kadish, AH
中科院分区：
文献类型：
--
作者：
Amar, D;Zhang, H;Kadish, AH
背景：胸外科手术后易患心房颤动（AF）的患者的识别将使那些最有可能从预防性治疗中获益的患者成为可能。本研究的目的是评估预测该并发症的容易获得的临床特征的准确性。方法：从正在进行的前瞻性数据库中选择接受重大择期胸外科手术的患者。结果：527例患者中，术后住院房颤发生率为79例（15%）。采用切点方法学和logistic回归，作者确定了与房颤独立相关的两个术前危险因素：60岁及以上（P = 0.0007）和入院前心电图心率74次/分及以上（P = 0.005）。在增加的年龄类别（< 60岁，60-69岁，大于或等于70岁）之间，发生房颤的几率增加了2.5倍（95%置信区间，1.7-3.4,P < 0.0001），在心率类别（< 74次/分钟，大于或等于74次/分钟）之间，增加了2.3倍（95%置信区间，1.4-3.8,P < 0.0007）。年龄≥60岁，术前心率≥74次/分预测房颤的敏感性为73%，特异性为57%。标准心电图测得的最大P波持续时间不能区分发生或未发生房颤的患者。发生房颤的患者术后肺炎的发生率较高（14% vs. 4%; P = 0.001），急性呼吸衰竭的发生率较高。1.6%;P = 0.01)，住院时间较长（17±17 ns）。10±9天；P = 0.001)和30天死亡率（11% vs. 3%; P = 0.001）。结论：高龄和术前心率可识别胸外科术后发生房颤的高危患者。术后房颤更常发生在术后发病率和住院时间较长的患者中。
Background Identification of patients vulnerable for atrial fibrillation (AF) after major thoracic surgery will allow targeting those most likely to benefit from prophylactic therapy. The goal of the current study was to evaluate the accuracy of easily available clinical characteristics for the prediction of this complication.Methods: Patients undergoing major elective thoracic surgery were chosen from an ongoing prospective database.Results: Postoperative in-hospital AF occurred in 79 (15%) of 527 patients Using cut-point methodology and logistic regression, the authors identified two preoperative risk factors independently associated with AF: age 60 yr or older (P = 0.0007) and heart rate 74 beats/min or greater on preadmission electrocardiogram (P = 0.005). The odds of developing AF increased by a factor of 2.5 (95% confidence interval, 1.7-3.4; P < 0.0001) between incremental age categories (< 60 yr, 60-69 yr, greater than or equal to 70 yr) and by a factor of 2.3 (95% confidence interval, 1.4-3.8; P < 0.0007) between heart rate categories (< 74 beats/min, greater than or equal to 74 beats/min). The combination of age 60 yr or older and preoperative heart rate 74 beats/min or greater predicted AF with a sensitivity of 73% and specificity of 57%. Maximum P-wave duration as measured from standard electrocardiogram did not differentiate patients who did or did not develop AF. Patients who developed AF had a higher incidence of postoperative pneumonia (14 vs. 4%; P = 0.001), acute respiratory failure (8 us. 1.6%; P = 0.01), greater hospital stay (17 +/- 17 ns. 10 +/- 9 days; P = 0.001) and 30-day mortality (11 vs. 3%; P = 0.001) when compared with those who did not develop AF, respectively.Conclusions: Advanced age and preoperative heart rate identify patients at high risk for development of AF after thoracic surgery. Postoperative AF occurs more frequently in patients with greater postoperative morbidity and length of hospitalization.