New risk score for predicting postoperative atrial fibrillation after cardiac surgery
DOI:
https://doi.org/10.24207/jca.v38.3562Keywords:
Atrial fibrillation, Postoperative Complications, Cardiac surgery, Risk scoreAbstract
Introduction: Postoperative atrial fibrillation is the most common sustained arrhythmia after cardiac surgeries that occurs in approximately 30-50% of patients postoperatively. Because of the substantial evidence recommending prophylactic treatment and the lack of clear indications for commencing treatment, this study aimed to develop a new predictive score for atrial fibrillation after cardiac surgery that represents well the pathophysiology of the disease. Methods: This is a retrospective cohort study, involving two public teaching hospitals. The study included 989 adult patients who underwent cardiac surgery, except for heart transplantation or the implantation of a ventricular assist device. Patients with previous atrial fibrillation or those requiring amiodarone were excluded. The variables (age ≥60 years, echocardiographic LA enlargement, inotrope use within 24 hours of surgery, and the need for reoperation) were subjected to univariate analysis of the occurrence of postoperative atrial fibrillation and multivariate analysis using logistic regression. This was then used for developing a risk score. Results: Statistically significant variables in the multivariate analysis were age ≥60 years (P<.001), left atrial enlargement based on echocardiography (P=.025), inotrope use within 24 hours after surgery (P=.002), and the need for reoperation within 24 hours after surgery (P=.016). The score comprises these four variables and has an accuracy of 77% for predicting outcomes. Scores ≥3 were related to a 34% risk of postoperative atrial fibrillation. Conclusions: The proposed score represents the disease pathophysiology well and has good accuracy for predicting the main outcome.
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