Bedside tool for predicting the risk of postoperative atrial fibrillation after cardiac surgery: the POAF score

Giovanni Mariscalco, Fausto Biancari, Marco Zanobini, Marzia Cottini, Gabriele Piffaretti, Matteo Saccocci, Maciej Banach, Cesare Beghi, Gianni D Angelini, Giovanni Mariscalco, Fausto Biancari, Marco Zanobini, Marzia Cottini, Gabriele Piffaretti, Matteo Saccocci, Maciej Banach, Cesare Beghi, Gianni D Angelini

Abstract

Background: Atrial fibrillation (AF) remains the most common complication after cardiac surgery. The present study aim was to derive an effective bedside tool to predict postoperative AF and its related complications.

Methods and results: Data of 17 262 patients undergoing adult cardiac surgery were retrieved at 3 European university hospitals. A risk score for postoperative AF (POAF score) was derived and validated. In the overall series, 4561 patients (26.4%) developed postoperative AF. In the derivation cohort age, chronic obstructive pulmonary disease, emergency operation, preoperative intra-aortic balloon pump, left ventricular ejection fraction <30%, estimated glomerular filtration rate <15 mL/min per m(2) or dialysis, and any heart valve surgery were independent AF predictors. POAF score was calculated by summing weighting points for each independent AF predictor. According to the prediction model, the incidences of postoperative AF in the derivation cohort were 0, 11.1%; 1, 20.1%; 2, 28.7%; and ≥3, 40.9% (P<0.001), and in the validation cohort they were 0, 13.2%; 1, 19.5%; 2, 29.9%; and ≥3, 42.5% (P<0.001). Patients with a POAF score ≥3, compared with those without arrhythmia, revealed an increased risk of hospital mortality (5.5% versus 3.2%, P=0.001), death after the first postoperative day (5.1% versus 2.6%, P<0.001), cerebrovascular accident (7.8% versus 4.2%, P<0.001), acute kidney injury (15.1% versus 7.1%, P<0.001), renal replacement therapy (3.8% versus 1.4%, P<0.001), and length of hospital stay (mean 13.2 versus 10.2 days, P<0.001).

Conclusions: The POAF score is a simple, accurate bedside tool to predict postoperative AF and its related or accompanying complications.

Keywords: antiarrhythmic prevention; atrial fibrillation; cardiac surgery; risk stratification.

Figures

Figure 1.
Figure 1.
Incidence of postoperative atrial fibrillation (POAF) according to POAF score in the derivation and validation cohorts (both cohorts, Cochran–Armitage test: P<0.001).
Figure 2.
Figure 2.
Correlation between postoperative atrial fibrillation (POAF) score and predicted probability of POAFoccurrence.
Figure 3.
Figure 3.
Postoperative complication (hospital mortality, cerebrovascular accident, acute kidney injury, and renal replacement therapy) rates according to the postoperative atrial fibrillation (POAF) score and the occurrence of POAF. P values are within each risk class.

References

    1. Shen J, Lall S, Zheng V, Buckley P, Damiano RJ, Schuessler RB. The persistent problem of new‐onset postoperative atrial fibrillation: a single‐institution experience over two decades. J Thorac Cardiovasc Surg. 2011; 141:559-570
    1. Villareal RP, Hariharan R, Liu BC, Kar B, Lee VV, Elayda M, Lopez JA, Rasekh A, Wilson JM, Massumi A. Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. J Am Coll Cardiol. 2004; 43:742-748
    1. Mariscalco G, Klersy C, Zanobini M, Banach M, Ferrarese S, Borsani P, Cantore C, Biglioli P, Sala A. Atrial fibrillation after isolated coronary surgery affects late survival. Circulation. 2008; 118:1612-1618
    1. Mahoney EM, Thompson TD, Veledar E, Williams J, Weintraub WS. Cost‐effectiveness of targeting patients undergoing cardiac surgery for therapy with intravenous amiodarone to prevent atrial fibrillation. J Am Coll Cardiol. 2002; 40:737-745
    1. Mariscalco G, Engström KG. Atrial fibrillation after cardiac surgery: risk factors and their temporal relationship in prophylactic drug strategy decision. Int J Cardiol. 2008; 129:354-362
    1. Zaman AG, Archbold A, Helft G, Paul EA, Curzen NP, Mills PG. Atrial fibrillation after coronary artery bypass surgery: a model for preoperative stratification. Circulation. 2000; 101:1403-1408
    1. Amar D, Shi W, Hogue CW, Zhang H, Passman RS, Thomas B, Bach PB, Damiano R, Thaler HT. Clinical prediction rule for atrial fibrillation after coronary artery bypass grafting. J Am Coll Cardiol. 2004; 44:1248-1253
    1. Mathew JP, Fontes ML, Tudor IC, Ramsay J, Duke P, Mazer CD, Barash PG, Hsu PH, Mangano DT. A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA. 2004; 291:1720-1729
    1. Magee MJ, Herbert MA, Dewey TM, Edgerton JR, Ryan WH, Prince S, Mack MJ. Atrial fibrillation after coronary artery bypass grafting surgery: development of a predictive risk algorithm. Ann Thorac Surg. 2007; 83:1707-1712
    1. Thorén E, Hellgren L, Jidéus L, Ståhle E. Prediction of postoperative atrial fibrillation in a large coronary artery bypass grafting cohort. Interact Cardiovasc Thorac Surg. 2012; 14:588-593
    1. Weber UK, Osswald S, Huber M, Buser P, Skarvan K, Stulz P, Schmidhauser C, Pfisterer M. Selective versus non‐selective antiarrhythmic approach for prevention of atrial fibrillation after coronary surgery: is there a need for pre‐operative risk stratification? A prospective placebo‐controlled study using low‐dose sotalol. Eur Heart J. 1998; 19:794-800
    1. Mariscalco G, Cederlund B, Engström KG. The clinical noncompliance of oral sotalol/magnesium for prophylactic treatment of atrial fibrillation after coronary artery bypass grafting. J Card Surg. 2007; 22:281-286
    1. Mariscalco G, Lorusso R, Klersy C, Ferrarese S, Tozzi M, Vanoli D, Domenico BV, Sala A. Observational study on the beneficial effect of preoperative statins in reducing atrial fibrillation after coronary surgery. Ann Thorac Surg. 2007; 84:1158-1164
    1. Miceli A, Fino C, Fiorani B, Yeatman M, Narayan P, Angelini GD, Caputo M. Effects of preoperative statin treatment on the incidence of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting. Ann Thorac Surg. 2009; 87:1853-1858
    1. Ascione R, Caputo M, Calori G, Lloyd CT, Underwood MJ, Angelini GD. Predictors of atrial fibrillation after conventional and beating heart coronary surgery: a prospective randomized study. Circulation. 2000; 102:1530-1535
    1. Watters M, Ascione R, Ryder IG, Ciulli F, Pitsis AA, Angelini GD. Hemodynamic changes during beating heart coronary surgery with the “Bristol Technique”. Eur J Cardiothorac Surg. 2001; 19:34-40
    1. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky PAcute Dialysis Quality Initiative workgroup. Acute renal failure–definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004; 8:R204-R212
    1. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999; 130:461-470
    1. Lipsky BA, Weigelt JA, Sun X, Johannes RS, Derby KG, Tabak YP. Developing and validating a risk score for lower‐extremity amputation in patients hospitalized for a diabetic foot infection. Diabetes Care. 2011; 34:1695-1700
    1. Banach M, Misztal M, Goch A, Rysz J, Goch JH. Predictors of atrial fibrillation in patients following isolated surgical revascularization. A metaanalysis of 9 studies with 28 786 patients. Arch Med Sci. 2007; 3:229-239
    1. Banach M, Kourliouros A, Reinhart KM, Benussi S, Mikhailidis DP, Jahangiri M, Baker WL, Galanti A, Rysz J, Camm JA, White CM, Alfieri O. Postoperative atrial fibrillation—what do we really know? Curr Vasc Pharmacol. 2010; 8:553-572
    1. Banach M, Mariscalco G, Ugurlucan M, Mikhailidis DP, Barylski M, Rysz J. The significance of preoperative atrial fibrillation in patients undergoing cardiac surgery: preoperative atrial fibrillation—still underestimated opponent. Europace. 2008; 10:1266-1270
    1. Ad N, Barnett SD, Hann CK, O'Brien SM, Milford‐Beland S, Speir AM. Does preoperative atrial fibrillation increase the risk for mortality and morbidity after coronary artery bypass grafting? J Thorac Cardiovasc Surg. 2009; 137:901-906
    1. Barnett SD, Ad N. Surgical ablation as treatment for the elimination of atrial fibrillation: a meta‐analysis. J Thorac Cardiovasc Surg. 2007; 133:182-189
    1. Arsenault KA, Yusuf AM, Crystal E, Healey JS, Morillo CA, Nair GM, Whitlock RP. Interventions for preventing post‐operative atrial fibrillation in patients undergoing heart surgery. Cochrane Database Syst Rev. 2013; 1:CD003611.
    1. Buckley MS, Nolan PE, Jr, Slack MK, Tisdale JE, Hilleman DE, Copeland JG. Amiodarone prophylaxis after cardiac surgery: meta‐analysis of dose response and timing of initiation. Pharmacotherapy. 2007; 27:360-368
    1. Mariscalco G, Sarzi‐Braga S, Banach M, Borsani P, Bruno VD, Napoleone M, Vitale C, Piffaretti G, Pedretti RFE, Sala A. Preoperative n‐3 polyunsatured fatty acids are associated with a decrease in the incidence of early atrial fibrillation following cardiac surgery. Angiology. 2010; 61:643-650
    1. Mariscalco G, Engström KG. Postoperative atrial fibrillation is associated with late mortality after coronary surgery, but not after valvular surgery. Ann Thorac Surg. 2009; 88:1871-1876
    1. Lahtinen J, Biancari F, Salmela E, Mosorin M, Satta J, Rainio P, Rimpiläinen J, Lepojärvi M, Juvonen T. Postoperative atrial fibrillation is a major cause of stroke after on‐pump coronary artery bypass surgery. Ann Thorac Surg. 2004; 77:1241-1244
    1. Kollar A, Lick SD, Vasquez KN, Conti VR. Relationship of atrial fibrillation and stroke after coronary artery bypass graft surgery: when is anticoagulation indicated? Ann Thorac Surg. 2006; 82:515-523
    1. Kim R, Baumgartner N, Clements J. Routine left atrial appendage ligation during cardiac surgery may prevent postoperative atrial fibrillation‐related cerebrovascular accident. J Thorac Cardiovasc Surg. 2013; 145:582-589

Source: PubMed

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