Post Coronary Bypass Atrial Arrhythmic Prediction Rule

描述（由申请人提供）： 该研究旨在开发和验证临床预测规则 冠状动脉旁路移植术（CABG）后房颤和心房颤动 扑动（AF）。这些心律失常发生在50万患者中的20 - 40%。 接受CABG，并增加发病率，费用和住院时间 与手术有关。尽管一些研究表明， β-肾上腺素能阻滞剂预防性治疗可降低 CABG术后AF，这种疗效尚未得到普遍认可。作为 结果，几种新的预防性治疗方法已经被引入，尽管有些 并伴有明显的毒性。因此必须 先验地识别那些最有可能发生CABG后的个体 AF，以及那些不太可能发展此终点的患者。通过这种方式，那些 最有可能发生CABG后AF的个体可能是 预防性治疗，而那些在低风险类别可能会幸免于难， 暴露于潜在有害的治疗，他们不太可能 从中获益。此外，确定高风险亚组 将允许执行较小的随机对照试验，并可能 深入了解CABG术后房颤的病因。 该研究是一项回顾性队列研究，旨在确定治疗前、治疗期间 以及可能与CABG术后AF相关的术后变量。 根据这些结果，将制定临床预测规则。验证 预测规则将在前瞻性队列研究中使用 不同的患者群体，规则是从哪里来的。这将允许 用于评估有效性和普遍性。 这位候选人致力于成为一名无党派人士 研究者，对严格的流行病学应用感兴趣 技术问题的重要性，在心脏电生理学，他的 临床专业领域。该项目将成为 候选人？的职业发展计划和他作为一名流行病学家的成熟， 心脏电生理学家和临床研究者。

DESCRIPTION (provided by applicant): The proposed study seeks to develop and validate a clinical prediction rule for post-coronary artery bypass grafting (CABG) atrial fibrillation and atrial flutter (AF). These arrhythmias occur in 20-40% of the 500,000 patients undergoing CABG, and increase the morbidity, cost, and length of stay associated with the procedure. Though several studies have suggested that prophylactic therapy with beta-adrenergic blockers decreases the risk of post-CABG AF, this efficacy has not been universally appreciated. As a result, several new prophylactic therapies have been introduced, though some with significant toxicities associated with them. It is therefore imperative to identify a priori those individuals most at risk of developing post-CABG AF, as well as those unlikely to develop this endpoint. In this manner, those individuals most at risk of developing post-CABG AF may be targeted for prophylactic therapy, while those in a low risk category may be spared the exposure to a potentially deleterious therapy from which they are less likely to derive benefit. Additionally, the identification of a high-risk subgroup would allow for the execution of smaller randomized controlled trials, and may provide insight into the etiology of post-CABG AF. The study is a retrospective cohort study designed to identify pre-, intra-, and post-operative variables which may be associated with post-CABG AF. From these results, a clinical prediction rule will be formulated. Validation of the prediction rule will then take place in a prospective cohort study using a different group of patients from which the rule was derived. This will allow for the assessment of both validity and generalizability. The candidate has committed himself to a career as an independent investigator, with an interest in the application of rigorous epidemiologic techniques to questions of importance in cardiac electrophysiology, his area of clinical expertise. This project will be an integral part of the candidate?s career development plan and his maturation as an epidemiologist, cardiac electrophysiologist, and clinical investigator.