R. Kashani1, S. Sareh1, K. Yefsky1, C. Hershey1, C. Rezentes1, N. Satou1, B. Genovese1, R. Shemin1, P. Benharash1 1David Geffen School Of Medicine, University Of California At Los Angeles,Division Of Cardiothoracic Surgery,Los Angeles, CA, USA
Introduction: Atrial fibrillation after cardiac surgery (POAF) is a common complication and is associated with increased morbidity and costs of care. Identification of patients at high risk for developing POAF is critical to targeted prophylaxis strategies. While various clinical, operative, and anatomic risk factors have been used to estimate the risk for POAF, a practical scoring system to identify such patients is lacking. Since the CHA2DS2-VASc scoring system is widely utilized to predict stroke risk in patients with atrial fibrillation (AF), we hypothesized that it may also serve as a strong predictor of POAF. The present study evaluated the utility of the CHA2DS2-VASc scoring system in predicting de-novo POAF after cardiac operations.
Methods: A total of 3836 patients who underwent cardiac surgery from 2008 to 2014 at our institution were identified for analysis. Exclusion criteria included previous history of atrial fibrillation/flutter, operations or medications for arrhythmia, transplants, or the use of extracorporeal membrane oxygenation and ventricular assist devices. For patients that met the inclusion criteria (2385), a CHA2DS2-VASc score (0-9) was calculated using the institutional Adult Cardiac Surgery Database. POAF within 30 days of the original operation lasting for greater than 30-seconds was the primary outcome measure. Based on CHA2DS2-VASc scores, patients were then grouped into low (0), moderate (1) and high (≥ 2) risk groups. A multivariate regression model was developed using Stata 12.1 (StataCorp, College Station TX) to adjust for other risk factors of POAF including gender, valvular operations, smoking, dyslipidemia, renal failure, use of beta blockers and statins, anemia, and both mitral and aortic insufficiency.
Results: Of the 2385 (66% male) patients included for analysis, 380 (16%) patients developed POAF. CHA2DS2-VASc scores for patients with and without AF were 3.4 ± 1.8 and 2.6 ± 1.8 (p<0.001), respectively. The majority of patients (74%) were categorized as high risk while another 12% comprised the moderate risk group. When compared to the low risk group, the odds of developing POAF increased two-fold and five-fold in the moderate and high-risk groups, respectively (p<0.001). As the CHA2DS2-VASc score increased from 0-9, the predicted risk of POAF increased from 9% to 42% (p<0.001). Using a cutoff score of 1, sensitivity and specificity for detecting POAF were 88% and 30%, respectively.
Conclusion: The commonly used CHA2DS2-VASc score is a highly-sensitive predictor of POAF. This scoring system should be utilized to identify at-risk patients who may benefit from prophylaxis strategies against POAF.
