Author + information
- Received March 23, 2004
- Revision received May 4, 2004
- Accepted May 11, 2004
- Published online September 15, 2004.
- David Amar, MD*,* (, )
- Weiji Shi, MS†,
- Charles W. Hogue Jr, MD‡,
- Hao Zhang, MD*,
- Rod S. Passman, MD∥,
- Betsy Thomas, RN‡,
- Peter B. Bach, MD†,
- Ralph Damiano, MD§ and
- Howard T. Thaler, PhD†
- ↵*Reprint requests and correspondence:
Dr. David Amar, Professor of Anesthesiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, M-304, New York, New York 10021
Objectives This study was designed to devise and validate a practical prediction rule for atrial fibrillation/atrial flutter (AF) after coronary artery bypass grafting (CABG) using easily available clinical and standard electrocardiographic (ECG) criteria.
Background Reported prediction rules for postoperative AF have suffered from inconsistent results and controversy surrounding the added predictive value of a prolonged P-wave duration.
Methods In 1,851 consecutive patients undergoing CABG with cardiopulmonary bypass, preoperative clinical characteristics and standard 12-lead ECG data were examined. Patients were continuously monitored for the occurrence of sustained postoperative AF while hospitalized. Multiple logistic regression was used to determine significant predictors of AF and to develop a prediction rule that was evaluated through jackknifing.
Results Atrial fibrillation occurred in 508 of 1,553 patients (33%). Multivariate analysis showed that greater age (odds ratio [OR] 1.1 per year [95% confidence intervals (CI) 1.0 to 1.1], p < 0.0001), prior history of AF (OR 3.7 [95% CI 2.3 to 6.0], p < 0.0001), P-wave duration >110 ms (OR 1.3 [95% CI 1.1 to 1.7], p = 0.02), and postoperative low cardiac output (OR 3.0 [95% CI 1.7 to 5.2], p = 0.0001) were independently associated with AF risk. Using the prediction rule we defined three risk categories for AF: <60 points, 61 of 446 (14%); 60 to 79 points, 330 of 908 (36%); and ≥80 points, 117 of 199 (59%). The area under the receiver-operator characteristic curve for the model was 0.69.
Conclusions These data show that post-CABG AF can be predicted with moderate accuracy using easily available patient characteristics and may prove useful in prognostic and risk stratification of patients after CABG. The presence of intraatrial conduction delay on ECG contributed least to the prediction model.
Presented in part at the 53rd Annual Scientific Session of the American College of Cardiology, March 2004, New Orleans, Louisiana.
- Received March 23, 2004.
- Revision received May 4, 2004.
- Accepted May 11, 2004.
- American College of Cardiology Foundation