- 作者：Diem T.T. Tran ; MD ; MSc* ; dtran@ottawaheart.ca" class="auth_mail" title="E-mail the corresponding author ; Jeffery J. Perry ; MD ; MSc§ ; ; Jean-Yves Dupuis ; MD* ; Elsayed Elmestekawy ; MD&dagger ; ; George A. Wells ; PhD&Dagger ;
- 关键词：postoperative complication ; cardiac surgery ; atrial fibrillation ; prediction rule
- 刊名：Journal of Cardiothoracic and Vascular Anesthesia
- 出版年：2015
- 出版时间：October 2015
- 年：2015
- 卷：29
- 期：5
- 页码：1117-1126
- 全文大小：244 K
Design
Retrospective analysis on prospectively collected observational data.
Setting
A university-affiliated cardiac hospital.
Participants
Adult patients undergoing coronary artery bypass grafting and/or valve surgery.
Interventions
Observation for the occurrence of new-onset postoperative atrial fibrillation.
Measurements and Main Results
Details on 28 preoperative variables from 999 patients were collected and significant predictors (p<0.2) were inserted into multivariable logistic regression and reconfirmed with recursive partitioning. A total of 305 (30.5%) patients developed new-onset POAF. Eleven variables were associated significantly with atrial fibrillation. A multivariable logistic regression model included left atrial dilatation, mitral valve disease, and age. Coefficients from the model were converted into a simple 7-point predictive score. The risk of POAF per score is: 15.0%, if 0; 20%, if 1; 27%, if 2; 35%, if 3; 44%, if 4; 53%, if 5; 62%, if 6; and 70%, if 7. A score of 4 has a sensitivity of 44% and a specificity of 82% for POAF. A score of 6 has a sensitivity of 11% and a specificity of 97%. Bootstrapping with 5,000 samples confirmed the final model provided consistent predictions.
Conclusions
This study proposed a simple predictive score incorporating three risk variables to identify cardiac surgical patients at high risk of developing new-onset POAF. Preventive treatment should target patients≥65 years with left atrial dilatation and mitral valve disease.