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Predictors of atrial fibrillation post coronary artery bypass graft surgery: new scoring system
Kian Lotter1,2, Sumit Yadav2,3, Pankaj Saxena2,3
1Intensive Care, Townsville Hospital and Health Service, Townsville, Queensland, Australia ks.lotter.7@gmail.com.
Insights
Postoperative atrial fibrillation (POAF) after coronary artery bypass graft (CABG) surgery is common. New predictors like age, p-wave duration, HATCH score, and cardiopulmonary bypass time can help identify at-risk patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Informatics
Background:
- Postoperative atrial fibrillation (POAF) is a frequent complication after coronary artery bypass graft (CABG) surgery.
- POAF significantly increases hospital stay duration and healthcare costs.
Purpose of the Study:
- To identify predictors of POAF following CABG.
- To develop a novel predictive screening tool for POAF.
Main Methods:
- A retrospective case-control study involving 388 patients undergoing CABG.
- Analysis of demographic data, traditional AF risk factors (HATCH score), ECG features, and perioperative variables.
- Development and validation of a predictive model using multivariate analysis and ROC curves.
Main Results:
- Older age, higher HATCH score, increased p-wave duration (≥100 ms), and longer cardiopulmonary bypass (CBP) time (≥100 min) were independently associated with POAF.
- The HATCH-PC score, incorporating these factors, demonstrated improved predictive accuracy.
Conclusions:
- Patients with HATCH scores ≥2, p-wave duration >100 ms, or CBP time >100 min face a higher risk of developing POAF post-CABG.
- The HATCH-PC score offers a more sensitive tool for screening patients at risk of POAF.
Background:
Atrial fibrillation (AF) following coronary artery bypass graft surgery (CABG) is common and results in significant increases in hospital stay and financial encumbrance.
Objective:
Determine and use the predictors of postoperative AF (POAF) following CABG to develop a new predictive screening tool.
Method:
A retrospective case-control study evaluated 388 patients (98 developed POAF and 290 remained in sinus rhythm) who undertook CABG surgery at Townsville University Hospital between 2016 and 2017. The demographic profile, risk factors for AF including hypertension, age≥75 years, transient ischaemic attack or stroke, chronic obstructive pulmonary disease (HATCH) score, electrocardiography features and perioperative factors were determined.
Results:
Patients who developed POAF were significantly older. On univariate analysis HATCH score, aortic regurgitation, increased p-wave duration and amplitude in lead II and terminal p-wave amplitude in lead V1 were associated with POAF; as were increased cardiopulmonary bypass time (103.5±33.9 vs 90.6±26.4 min, p=0.001) and increased cross clamp time. On multivariate analysis age (p=0.038), p-wave duration ≥100 ms (p=0.005), HATCH score (p=0.049) and CBP Time ≥100 min (p=0.001) were associated with POAF. Receiver operating characteristic curve demonstrated that with a cut-off of ≥2 for HATCH score, POAF could be predicted with a sensitivity of 72.8% and a specificity of 34.7%. Adding p-wave duration in lead II >100 ms and cardiopulmonary bypass time >100 min to the HATCH score increased the sensitivity to 83.7% with a specificity of 33.1%. This was termed the HATCH-PC score.
Conclusion:
Patients with HATCH scores ≥2, and those with p-wave duration >100 ms, or cardiopulmonary bypass time >100 min were at greater risk of developing POAF following CABG.
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