Key result
The PAFAC score, incorporating age >60 years, White race, GFR <90 mL/min, and left atrial diameter >4.5 cm, strongly predicted new onset atrial fibrillation after isolated CABG (r=0.92).
Why the study?
Atrial fibrillation is common after cardiac surgery and contributes to increased morbidity and mortality, prompting the derivation and validation of a predictive model for AF after CABG incorporating novel echocardiographic and laboratory values.
Can the PAFAC score reliably predict new-onset atrial fibrillation in patients undergoing isolated CABG?
Cohort (n=762)
No
Can the PAFAC score reliably predict new-onset atrial fibrillation in patients undergoing isolated CABG?
Effect estimate: r = 0.92
The PAFAC score is a simple, 4-variable tool that can reliably identify patients at high risk of developing atrial fibrillation after isolated CABG.
The PAFAC score may support early AF risk stratification after CABG; leaves open external validation and outcome impact before practice change.
BACKGROUND: Atrial fibrillation (AF) is common after cardiac surgery and contributes to increased morbidity and mortality. Our objective was to derive and validate a predictive model for AF after CABG in patients, incorporating novel echocardiographic and laboratory values. METHODS: We retrospectively reviewed patients at our institution without preexisting dysrhythmia who underwent on-pump, isolated CABG from 2011-2015. The primary outcome was new onset AF lasting >1 hour on continuous telemetry or requiring medical treatment. Patients with a preoperative echocardiographic measurement of left atrial diameter were included in a risk model, and were randomly divided into derivation (80%) and validation (20%) cohorts. The predictors of AF after CABG (PAFAC) score was derived from a multivariable logistic regression model by multiplying the adjusted odds ratios of significant risk factors (P < .05) by a factor of 4 to derive an integer point system. RESULTS: 1307 patients underwent isolated CABG, including 762/1307 patients with a preoperative left atrial diameter measurement. 209/762 patients (27%) developed new onset AF including 165/611 (27%) in the derivation cohort. We identified four risk factors independently associated with postoperative AF which comprised the PAFAC score: age > 60 years (5 points), White race (5 points), baseline GFR < 90 mL/min (4 points) and left atrial diameter > 4.5 cm (4 points). Scores ranged from 0-18. The PAFAC score was then applied to the validation cohort and predicted incidence of AF strongly correlated with observed incidence (r = 0.92). CONCLUSION: The PAFAC score is easy to calculate and can be used upon ICU admission to reliably identify patients at high risk of developing AF after isolated CABG.
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Lin et al. (2018) conducted a cohort in Atrial fibrillation after isolated CABG (n=762). PAFAC score was evaluated on New onset AF lasting >1 hour on continuous telemetry or requiring medical treatment (r = 0.92). The PAFAC score, incorporating age >60 years, White race, GFR <90 mL/min, and left atrial diameter >4.5 cm, strongly predicted new onset atrial fibrillation after isolated CABG (r=0.92).
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