Prognostic model for atrial fibrillation after cardiac surgery: a UK cohort study.
Prognostic model for atrial fibrillation after cardiac surgery: a UK cohort study.
复制标题
心脏手术后心房颤动的预后模型：英国队列研究。
DOI：
10.1007/s00392-022-02068-1
复制
发表时间：
2023-03
期刊：
影响因子：
--
通讯作者：
中科院分区：
文献类型：
--
作者：
作为PARADISE项目（NIHR131227）的一部分，开发一种经验证的临床预后模型，以确定心脏手术后房颤的风险。前瞻性队列研究，其中链接了1998年至2016年英国临床实践研究数据链中560万人队列的电子健康记录。对于模型开发，我们考虑了先验候选预测因子，包括人口统计学、病史、药物和临床生物标志物。我们使用最小绝对收缩和选择算子的logistic回归评估了随访结束时协变量与AF发生率之间的相关性。该模型采用自助法进行内部验证;随后的性能通过c-统计量量化的区分度进行检查，并通过校准图评估校准。该研究遵循TRIPOD指南。在1998年至2016年期间，在5，601，803名符合条件的患者中，有33，464名患者接受了心脏手术。最终模型包括基线时的13个预测因子：年龄、首次手术年份、升高的CHA2DS2-VASc评分、充血性心力衰竭、高血压、急性冠状动脉综合征、二尖瓣疾病、室性心动过速、瓣膜手术、接受两种联合手术（例如，瓣膜置换术+冠状动脉旁路移植术），或首次手术中的三种联合手术，他汀类药物使用，以及除白色或黑色以外的种族（他汀类药物和种族具有保护作用）。对于推导和验证队列，该模型的优化校正C统计量均为0.68。校准良好。我们开发了一个模型来识别一组房颤和不良结局高风险的个体，这些个体可以从长期心律失常监测、风险因素管理、心律控制和/或血栓预防中获益。在线版本包含补充材料，可通过10.1007/s00392 - 022 - 02068 - 1获得。
To develop a validated clinical prognostic model to determine the risk of atrial fibrillation after cardiac surgery as part of the PARADISE project (NIHR131227). Prospective cohort study with linked electronic health records from a cohort of 5.6 million people in the United Kingdom Clinical Practice Research Datalink from 1998 to 2016. For model development, we considered a priori candidate predictors including demographics, medical history, medications, and clinical biomarkers. We evaluated associations between covariates and the AF incidence at the end of follow-up using logistic regression with the least absolute shrinkage and selection operator. The model was validated internally with the bootstrap method; subsequent performance was examined by discrimination quantified with the c-statistic and calibration assessed by calibration plots. The study follows TRIPOD guidelines. Between 1998 and 2016, 33,464 patients received cardiac surgery among the 5,601,803 eligible individuals. The final model included 13-predictors at baseline: age, year of index surgery, elevated CHA2DS2-VASc score, congestive heart failure, hypertension, acute coronary syndromes, mitral valve disease, ventricular tachycardia, valve surgery, receiving two combined procedures (e.g., valve replacement + coronary artery bypass grafting), or three combined procedures in the index procedure, statin use, and ethnicity other than white or black (statins and ethnicity were protective). This model had an optimism-corrected C-statistic of 0.68 both for the derivation and validation cohort. Calibration was good. We developed a model to identify a group of individuals at high risk of AF and adverse outcomes who could benefit from long-term arrhythmia monitoring, risk factor management, rhythm control and/or thromboprophylaxis. The online version contains supplementary material available at 10.1007/s00392-022-02068-1.
登录
查看更多内容
影响因子：
13.6
作者：
Padmanabhan, Shivani;Carty, Lucy;Strongman, Helen
通讯作者：
Strongman, Helen
影响因子：
9.3
作者：
Collins GS;Reitsma JB;Altman DG;Moons KG
通讯作者：
Moons KG
影响因子：
3.4
作者：
Herrett, Emily;Thomas, Sara L.;Hall, Andrew J.
通讯作者：
Hall, Andrew J.
影响因子：
3.7
作者：
Morley, Katherine I.;Wallace, Joshua;Hemingway, Harry
通讯作者：
Hemingway, Harry
影响因子：
5.7
作者：
Cameron, Matthew J.;Tran, Diem T. T.;Dupuis, Jean-Yves
通讯作者：
Dupuis, Jean-Yves