Predictive Accuracy of a Polygenic Risk Score for Postoperative Atrial Fibrillation After Cardiac Surgery.
Predictive Accuracy of a Polygenic Risk Score for Postoperative Atrial Fibrillation After Cardiac Surgery.
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DOI：
10.1161/circgen.120.003269
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发表时间：
2021-04
期刊：
影响因子：
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通讯作者：
Bastarache L
中科院分区：
文献类型：
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作者：
Kertai MD;Mosley JD;He J;Ramakrishnan A;Abdelmalak MJ;Hong Y;Shoemaker MB;Roden DM;Bastarache L
术后房颤（PoAF）仍然是心脏手术后发病率和死亡率增加的重要风险因素。通过临床风险因素准确识别风险患者的能力有限。越来越多的证据表明，多基因风险显着贡献PoAF，并纳入遗传风险的措施可以提高预测。一项回顾性队列研究，纳入了1,047例在三级学术中心接受冠状动脉旁路移植术（CABG）或瓣膜手术的欧洲白色血统患者，这些患者无病史或持续性术前AF。根据术后ECG报告、病历记录和药物变化，将主要结局定义为PoAF。该暴露是多基因风险评分（PRS），包括先前与AF风险相关的2，746个SNP。使用模型判别、校准和净重新分类改进（NRI）的措施评估PoAF风险的预测。共有259例患者（24.7%）出现PoAF。PRS与PoAF的高风险显著相关（PRS每增加一个标准差，OR = 1.63; 95% CI，1.41-1.90）。将PRS添加到PoAF的患者和手术相关预测因子中，将C统计量从0.742显著增加到0.782（C统计量变化，0.040; 95% CI，0.021-0.060），同时保持良好的校准。将PRS添加到术后AF的患者和手术相关预测因素中，改善了模型拟合（似然比检验p = 2.8 × 10−15），并显著改善了重新分类的测量结果（NRI，0.158; 95% CI，0.066- 0.274）。与传统临床预测因子相比，PoAF的PRS与改善的区分、校准和风险重新分类相关，表明PoAF PRS可增强接受CABG或瓣膜手术患者的PoAF风险预测。
Postoperative atrial fibrillation (PoAF) remains a significant risk factor for increased morbidity and mortality after cardiac surgery. The ability to accurately identify patients at risk through clinical risk factors is limited. There is growing evidence that polygenic risk contributes significantly to PoAF, and incorporating measures of genetic risk could enhance prediction. A retrospective cohort study of 1,047 patients of white European ancestry who underwent either coronary artery bypass grafting (CABG) or valve surgery at a tertiary academic center, and were free from a history or persistent preoperative AF. The primary outcome was defined as PoAF based on postoperative ECG reports, medical record documentation, and changes in medication. The exposure was a polygenic risk score (PRS) comprising 2,746 SNPs previously associated with AF risk. The prediction of PoAF risk was assessed using measures of model discrimination, calibration, and net reclassification improvement (NRI). A total of 259 patients (24.7%) developed PoAF. The PRS was significantly associated with a higher risk for PoAF (OR = 1.63 per standard deviation increase in PRS; 95% CI, 1.41–1.90). Addition of PRS to patient- and procedure-related predictors of PoAF significantly increased the C statistic from 0.742 to 0.782 (change in C statistic, 0.040; 95% CI, 0.021–0.060) while maintaining good calibration. The addition of the PRS to patient- and procedure-related predictors of postoperative AF improved model fit (likelihood ratio test p = 2.8 × 10−15) and significantly improved measures of reclassification (NRI, 0.158; 95% CI, 0.066– 0.274). The PRS for PoAF was associated with improved discrimination, calibration, and risk reclassification compared to conventional clinical predictors suggesting that a PoAF PRS may enhance risk prediction of PoAF in patients undergoing CABG or valve surgery.