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Predicting New-Onset Post-Coronary Artery Bypass Graft Atrial Fibrillation With Existing Risk Scores
Benjamin D Pollock1, Giovanni Filardo2, Briget da Graca1
1Office of the Chief Quality Officer, Baylor Scott & White Health, Dallas, Texas.
Insights
New-onset atrial fibrillation (AF) after coronary artery bypass graft (CABG) surgery is common. The CHARGE-AF score showed the best predictive ability compared to other risk scores and age alone for identifying patients at high risk of post-CABG AF.
Area of Science:
- Cardiology
- Cardiac Surgery
- Epidemiology
Background:
- New-onset atrial fibrillation (AF) following coronary artery bypass graft (CABG) surgery is linked to reduced survival rates.
- Current prophylactic strategies have not significantly lowered AF incidence, highlighting the need for targeted prevention in high-risk individuals.
- Existing risk scores for general adverse outcomes or non-surgical AF may not accurately predict post-CABG AF.
Purpose of the Study:
- To compare the predictive performance of established risk scores (STS, CHARGE-AF, CHA2DS2-VASc, POAF) and age in identifying patients at risk for new-onset AF after CABG.
- To determine if existing scores can be repurposed for predicting post-CABG AF or if new models are needed.
Main Methods:
- Utilized data from 8,976 patients undergoing isolated CABG without prior AF, sourced from the STS Adult Cardiac Surgery Database.
- Employed logistic regression models with restricted cubic splines and random site effects to predict post-CABG AF using CHA2DS2-VASc, CHARGE-AF, POAF, STS risk scores, and age.
- Calculated and compared receiver operating characteristic (ROC) areas to evaluate the predictive accuracy of each model.
Main Results:
- New-onset AF was observed in 23.9% of patients (2,141 individuals).
- The CHARGE-AF score demonstrated the highest predictive ability (ROC area: 0.68), outperforming age (0.66) and other scores (POAF: 0.65, CHA2DS2-VASc: 0.59, STS: 0.58).
- CHARGE-AF was significantly more predictive than age (p < 0.0001), while other scores were significantly less predictive (p < 0.0001).
Conclusions:
- The CHARGE-AF score exhibited moderate predictive performance for post-CABG AF, surpassing age alone.
- Existing risk scores, including CHARGE-AF, show limitations in accurately predicting new-onset AF after isolated CABG.
- Further research is essential to develop more effective predictive models for post-CABG AF.
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.
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