Key result
Renal dysfunction was an independent predictor of postoperative atrial fibrillation, and adding it to the CHA2DS2-VASc score increased predictive accuracy (AUC 0.68 to 0.71, P<0.001).
Why the study?
Does the addition of renal dysfunction to the CHA2DS2-VASc score improve the prediction of postoperative atrial fibrillation in patients undergoing cardiac surgery?
Cohort (n=350)
Does the addition of renal dysfunction to the CHA2DS2-VASc score improve the prediction of postoperative atrial fibrillation in patients undergoing cardiac surgery?
Adding renal dysfunction to the CHA2DS2-VASc score modestly improves the prediction of postoperative atrial fibrillation after cardiac surgery.
May enhance POAF risk stratification after cardiac surgery; hypothesis-generating and requires prospective validation before clinical use.
AIMS: To investigate whether renal dysfunction is a useful predictor of postoperative atrial fibrillation (POAF) after cardiac surgery. We also aimed to determine whether the addition of renal dysfunction into the scoring system could improve diagnostic accuracy of the CHA2DS2-VASc score to predict POAF. METHODS AND RESULTS: The study prospectively enrolled 350 consecutive patients who underwent cardiac surgery. Echocardiography was performed before cardiac surgery. Renal dysfunction was defined as estimated glomerular filtration rate < 60 mL min(-1) 1.73 m(-2). All patients were monitored with continuous electrocardiographic telemetry for the occurrence of POAF until the day of hospital dismissal. Postoperative atrial fibrillation occurred in 103 of 350 patients (29%). Patients with POAF was associated with longer intensive care unit stay compared with those without POAF (3.7 ± 2.2 vs. 3.1 ± 1.4 days, P = 0.002). Both the CHA2DS2-VASc score and renal dysfunction were independent predictors of POAF in multivariate analysis. Renal dysfunction can further stratify patients with a CHA2DS2-VASc score of 0 or 1 into two groups with different POAF rates (3.1% vs. 68.8%, P < 0.001). A new scoring system (R-CHA2DS2-VASc score) derived by assigning an additional point representing renal dysfunction to the CHA2DS2-VASc score could improve its predictive accuracy. The area under the receiver operating characteristic curve increased from 0.68 to 0.71 (P < 0.001). Furthermore, the rate of left ventricular diastolic dysfunction also increased with increasing renal dysfunction. CONCLUSION: Renal dysfunction, associated with left ventricular diastolic dysfunction, was a significant risk factor for POAF after cardiac surgery and may improve the diagnostic accuracy of the CHA2DS2-VASc score.
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Chua et al. (2015) conducted a cohort in cardiac surgery (n=350). Renal dysfunction (eGFR < 60 mL/min/1.73 m2) vs. No renal dysfunction was evaluated on Postoperative atrial fibrillation (POAF). Renal dysfunction was an independent predictor of postoperative atrial fibrillation, and adding it to the CHA2DS2-VASc score increased predictive accuracy (AUC 0.68 to 0.71, P<0.001).
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