Predicting New-Onset Postoperative Atrial Fibrillation Following Isolated Coronary Artery Bypass Grafting: Development and Validation of a Novel Nomogram

Abstract

Objective To select variables associated with new-onset postoperative atrial fibrillation (POAF) following isolated coronary artery bypass grafting (CABG) and develop a nomogram for risk prediction in a Chinese population. Methods The study retrospectively enrolled 4854 consecutive patients undergoing isolated CABG from February 2018 to September 2019, they were divided into derivation cohort and validation cohort with a 3:1 ratio according to the order of operation date. In the derivation cohort, significant variables were selected by use of the multivariate logistic backward stepwise regression analysis and a nomogram model was built on the strength of the results. The model performance was assessed in terms of discrimination and calibration. Besides, we compared the discriminative ability for POAF of the nomogram with established prediction models (CHA2DS2-VASc and HATCH scores) in the two cohorts. Results POAF occurred in 1025 (28.2%) out of 3641 patients in the derivation cohort, and in 337 (27.8%) out of 1213 patients in the validation cohort. A nomogram, composed of eight prognostic variables, namely age, sex, heart rate, hypertension, left ventricular ejection fraction (LVEF) <50%, left atrial diameter (LAD) > 40mm, estimated glomerular filtration rate (eGFR) level, and on-pump surgery, was constructed from the derivation cohort. The nomogram had substantial discriminative ability in derivation and validation cohorts with the area under the receiver operating characteristic curves (AUCs) of 0.661 (95% confidence interval, 0.642–0.681) and 0.665 (95% confidence interval, 0.631–0.699), respectively, and showed well-fitted calibration curves. Compared with CHA2DS2-VASc, HATCH and POAF scores, respectively, the nomogram had superior discrimination performance. Conclusion We constructed a novel nomogram with improved accuracy for predicting the risk of POAF following isolated CABG, which might help clinicians predict individual probability of POAF and achieve effective prophylaxis.

Nomogram predicts atrial fibrillation after coronary artery bypass grafting

“…Therefore, we tried to remove the intraoperative information in the model, only used the preoperative information, and then remodeled it to observe the model detection efficiency. The model with 6 predictors (AUC = 0.707) had reduced power compared to the model with 7 predictors, but by including fewer variables before surgery, it achieved better predictive power than the predictive model established by Fan et al[ 14 ] Therefore, these two nomograms could identify POAF as early as possible.…”

“…However, no nomogram was used to predict the POAF. After the start of our trial, a paper using nomograms to predict POAF was published [ 14 ]. But, Fan et al have some deficiencies [ 14 ].…”

“…After the start of our trial, a paper using nomograms to predict POAF was published [ 14 ]. But, Fan et al have some deficiencies [ 14 ]. Based on previous studies, this study will propose two new nomograms.…”

Preoperative predictors of postoperative atrial fibrillation in patients undergoing cardiopulmonary bypass

“…The aim here is to reveal a more HATCH score and POAF score. 14,15 However, Ozsin et al 16 reported SYNTAX score II was not an independent predictor for the development of PoAF but they observed that higher SYNTAX score II was correlated with the development of PoAF.…”

“…The aim here is to reveal a more predictive factor for PoAF by assigning various scores to known risk factors according to their potency. The most commonly used ones are CHA2DS2‐VASc (Congestive heart failure, Hypertension Age [≥65 = 1 point, ≥75 = 2 points], Diabetes, and Stroke/transient ischemic attack (2 points)—vascular disease [peripheral arterial disease, previous myocardial infarction, aortic atheroma]) score, HATCH score and POAF score 14,15 . However, Ozsin et al 16 reported SYNTAX score II was not an independent predictor for the development of PoAF but they observed that higher SYNTAX score II was correlated with the development of PoAF.…”