Predicting New-Onset Post-Coronary Artery Bypass Graft Atrial Fibrillation With Existing Risk Scores

Benjamin D. Pollock, Giovanni Filardo, Briget da Graca, Teresa K. Phan, Gorav Ailawadi, Vinod Thourani, Ralph J. Damiano, James R. Edgerton

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Background New-onset atrial fibrillation (AF) after coronary artery bypass graft (CABG) operation is associated with poorer survival. Blanket prophylaxis efforts have not appreciably decreased incidence, making targeted prevention for high-risk patients desirable. We compared predictive abilities of existing scores developed/used to predict adverse CABG outcomes (Society of Thoracic Surgeons’ [STS] risk of mortality) or AF not associated with cardiac operation (the Cohorts for Heart and Aging Research in Genomic Epidemiology [CHARGE]-AF score, the CHA2DS2-VASc score), and a risk model for predicting postoperative AF following cardiac operations (POAF score), with age (the most consistently identified post-CABG AF risk factor). Methods Data submitted to the STS Adult Cardiac Surgery Database were used to assess new-onset AF in 8,976 consecutive patients without preoperative AF undergoing isolated CABG from 2004 to 2010 at five participating centers. Five logistic regression models (for CHA2DS2-VASc score, CHARGE-AF score, POAF score, STS risk score, and age, respectively, all modeled with restricted cubic splines) with a random effect for site were fitted to predict post-CABG AF. Estimates were used to compute and compare receiver operating characteristic (ROC) areas. Results New-onset AF occurred in 2,141 patients (23.9%). The ROC area was greatest for CHARGE-AF (0.68, 95% confidence interval [CI]: 0.67–0.69), followed by age (0.66, 95% CI: 0.65–0.68), POAF score (0.65, 95% CI: 0.64–0.66), CHA2DS2-VASc (0.59, 95% CI: 0.58 to 0.60), and STS risk of mortality (0.58, 95% CI: 0.56–0.59). CHARGE-AF was significantly more predictive than age (p < 0.0001); the other scores were significantly less predictive (p < 0.0001). Conclusions Only CHARGE-AF performed better than age alone. Its performance was moderate and comparable with published risk models specifically targeted at new-onset post-isolated CABG AF. Future research should continue to focus on developing better predictive models.

Original languageEnglish
Pages (from-to)115-121
Number of pages7
JournalAnnals of Thoracic Surgery
Volume105
Issue number1
DOIs
StatePublished - Jan 2018

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