Prediction of postoperative atrial fibrillation in a large coronary artery bypass grafting cohort
Prediction of postoperative atrial fibrillation in a large coronary artery bypass grafting cohort
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DOI：
10.1093/icvts/ivr162
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发表时间：
2012-05-01
影响因子：
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通讯作者：
Stahle, Elisabeth
中科院分区：
文献类型：
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作者：
Thoren, Emma;Hellgren, Laila;Stahle, Elisabeth
本研究的目的是在大型冠状动脉旁路移植术（CABG）队列中识别和评价术后房颤（POAF）的预测因素。这是一项在1996年1月至2009年12月期间接受单独CABG的7115例术前窦性心律连续患者中进行的单中心研究。POAF的独立危险因素采用多元Logistic回归分析。通过比较预测和观察到的POAF事件来评价最终模型的预测质量，以寻找发生POAF的高风险患者。CABG术后，2270例患者（32%）在住院期间发生POAF。POAF的独立危险因素包括年龄增长（优势比，OR 2.0-7.3）、术前S-肌酐≥ 150 μ mol/1（OR 1.6）、男性（OR 1.2）、纽约心脏协会III/IV级（OR 1.2）、吸烟（OR 1.1）、既往心肌梗死（OR 1.1）和无高脂血症（OR 0.9）。最终预测模型为中度（曲线下面积，0.62; 95%置信区间，0.61-0.64）。POAF患者术后并发症较多，包括卒中发生率较高和住院时间延长。总之，识别了POAF的几个危险因素，但预测模型的中等值证实了识别CABG后发生POAF的高风险患者的难度。
The objective of this study was to identify and evaluate predictors of postoperative atrial fibrillation (POAF) in a large coronary artery bypass grafting (CABG) cohort. This was a single centre study of 7115 consecutive patients with preoperative sinus rhythm who underwent isolated CABG between January 1996 and December 2009. Independent risk factors for POAF were identified with multiple logistic regression. The predictive quality of the final model was evaluated by comparing predicted and observed events of POAF, in an effort to find patients at high risk of developing POAF. After CABG, 2270 patients (32%) developed POAF during hospital stay. Independent risk factors of POAF included advancing age (odds ratio, OR 2.0-7.3), preoperative S-creatinine >= 1 50 mu mol/1 (OR 1.6), male gender (OR 1.2), New York Heart Association class III/IV (OR, 1.2), smoking (OR 1.1), prior myocardial infarction (OR 1.1) and absence of hyperlipidemia (OR 0.9). The final prediction model was moderate (area under curve, 0.62; 95% confidence interval, 0.61-0.64). Patients with POAF had more postoperative complications, including a higher incidence of stroke and increased length of hospital stay. In conclusion, several risk factors for POAF were identified, but the moderate value of the prediction model confirms the difficulty of identifying patients at high risk of developing POAF after CABG.