Key result
Novel 10-predictor model outperforms POAF score for post-CABG atrial fibrillation with AUC ~0.65.
Why the study?
New-onset atrial fibrillation is a frequent complication after CABG, and existing clinical risk scores have shown variable performance in surgical populations. Improved pre-operative risk stratification may facilitate targeted preventive strategies.
Does a 10-predictor pre-operative prediction model improve discrimination for new-onset atrial fibrillation compared with POAF and CHA₂DS₂-VASc scores in patients undergoing isolated CABG?
Cohort (n=4,810)
Yes
Does a 10-predictor pre-operative prediction model improve discrimination for new-onset atrial fibrillation compared with POAF and CHA₂DS₂-VASc scores in patients undergoing isolated CABG?
A novel 10-variable pre-operative prediction model for new-onset atrial fibrillation after isolated CABG outperformed existing risk scores (POAF and CHA₂DS₂-VASc) with preserved discrimination in external validation (AUC 0.692).
Background New-onset atrial fibrillation (NOAF) is a frequent complication following coronary artery bypass grafting (CABG) and is associated with prolonged hospitalisation and adverse outcomes. Existing clinical risk scores have shown variable performance in surgical populations. Improved pre-operative risk stratification may facilitate targeted preventive strategies. Purpose To develop and externally validate a transportable pre-operative prediction model for NOAF after CABG. As a secondary objective, we assessed whether adding intraoperative variables improved predictive performance. Methods Consecutive patients undergoing isolated CABG were identified from a Polish CABG cohort (development set). Patients with prior atrial fibrillation, active endocarditis during index hospitalisation, or concomitant mitral valve repair/replacement were excluded. The primary outcome was NOAF, defined by documented atrial fibrillation during postoperative monitoring during index hospitalisation. Candidate predictors included routinely available pre-operative demographic, clinical, laboratory, and echocardiographic variables. Model discrimination was assessed using cross-validated area under the receiver operating characteristic curve (AUC) and compared with established clinical risk scores (POAF score and CHA₂DS₂-VASc). The final model was refitted on the full development cohort and externally validated in an independent external CABG cohort. In a secondary analysis, intraoperative variables(off-pump CABG status, extracorporeal circulation time, and aortic clamping time) were added to assess incremental predictive value. Results The development cohort included 4,810 patients (mean age 65.2 ± 8.6 years; 26.1% female), of whom 17.8% developed NOAF. A penalised logistic regression model with 10 pre-operative predictors demonstrated the highest cross-validated discrimination (AUC 0.651 ± 0.030), outperforming the POAF score (AUC 0.61) and CHA₂DS₂-VASc score (AUC 0.59). In the final model, increasing age (OR 1.06, 95% CI 1.05–1.08), left atrial dimension (OR 1.49, 95% CI 1.25–1.77), heart failure (OR 1.44, 95% CI 1.08–1.91), and male sex (OR 1.29, 95% CI 1.08–1.55) were independently associated with POAF. External validation demonstrated preserved discrimination (AUC 0.692). In secondary analysis, adding intraoperative variables provided modest incremental improvement (internal AUC 0.655±0.029; external AUC 0.697). Conclusion A pre-operative prediction model for NOAF after CABG outperformed established clinical risk scores. Discrimination was preserved in external validation. The addition of intraoperative variables provided only modest incremental improvement, supporting the clinical utility of pre-operative risk stratification.Forest Plot for NOAFPerformance and Clinical Utility
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Li et al. (2026) conducted a cohort in New-onset atrial fibrillation after coronary artery bypass grafting (n=4,810). 10-predictor penalised logistic regression pre-operative prediction model vs. Established clinical risk scores (POAF score and CHA2DS2-VASc) was evaluated on New-onset atrial fibrillation (NOAF) during index hospitalisation (AUC 0.651). A 10-predictor pre-operative model for post-CABG atrial fibrillation outperformed POAF (AUC 0.651 vs 0.61) and CHA2DS2-VASc (AUC 0.59) scores, with preserved external validation (AUC 0.692).
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