Clinical prediction rule for atrial fibrillation after coronary artery bypass grafting Journal Article


Authors: Amar, D.; Shi, W.; Hogue, C. W. Jr; Zhang, H.; Passman, R. S.; Thomas, B.; Bach, P. B.; Damiano, R.; Thaler, H. T.
Article Title: Clinical prediction rule for atrial fibrillation after coronary artery bypass grafting
Abstract: This study was designed to devise and validate a practical prediction rule for atrial fibrillation/atrial flutter (AF) after coronary artery bypass grafting (CABG) using easily available clinical and standard electrocardiographic (ECG) criteria. Reported prediction rules for postoperative AF have suffered from inconsistent results and controversy surrounding the added predictive value of a prolonged P-wave duration. In 1,851 consecutive patients undergoing CABG with cardiopulmonary bypass, preoperative clinical characteristics and standard 12-lead ECG data were examined. Patients were continuously monitored for the occurrence of sustained postoperative AF while hospitalized. Multiple logistic regression was used to determine significant predictors of AF and to develop a prediction rule that was evaluated through jackknifing. Atrial fibrillation occurred in 508 of 1,553 patients (33%). Multivariate analysis showed that greater age (odds ratio [OR] 1.1 per year [95% confidence intervals (CI) 1.0 to 1.1], p < 0.0001), prior history of AF (OR 3.7 [95% CI 2.3 to 6.0], p < 0.0001), P-wave duration >110 ms (OR 1.3 [95% CI 1.1 to 1.7], p = 0.02), and postoperative low cardiac output (OR 3.0 [95% CI 1.7 to 5.2], p = 0.0001) were independently associated with AF risk. Using the prediction rule we defined three risk categories for AF: <60 points, 61 of 446 (14%); 60 to 79 points, 330 of 908 (36%); and ≥80 points, 117 of 199 (59%). The area under the receiver-operator characteristic curve for the model was 0.69. These data show that post-CABG AF can be predicted with moderate accuracy using easily available patient characteristics and may prove useful in prognostic and risk stratification of patients after CABG. The presence of intraatrial conduction delay on ECG contributed least to the prediction model. © 2004 by the American College of Cardiology Foundation.
Keywords: adult; controlled study; treatment outcome; aged; middle aged; patient satisfaction; major clinical study; disease course; disease association; patient monitoring; prediction; medical examination; postoperative complication; postoperative complications; confidence interval; coronary artery bypass graft; coronary artery bypass; hospitalization; correlation analysis; statistical significance; diagnostic value; cardiovascular risk; predictive value of tests; multivariate analysis; logistic regression analysis; heart atrium fibrillation; atrial fibrillation; electrocardiogram; roc curve; cardiopulmonary bypass; heart atrium flutter; atrial flutter; adrenergic beta-antagonists; humans; human; male; female; priority journal; article; p wave; cardiac output, low
Journal Title: Journal of the American College of Cardiology
Volume: 44
Issue: 6
ISSN: 0735-1097
Publisher: Elsevier Science, Inc.  
Date Published: 2004-09-15
Start Page: 1248
End Page: 1253
Language: English
DOI: 10.1016/j.jacc.2004.05.078
PROVIDER: scopus
PUBMED: 15364327
DOI/URL:
Notes: J. Am. Coll. Cardiol. -- Cited By (since 1996):77 -- Export Date: 16 June 2014 -- CODEN: JACCD -- Source: Scopus
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Citation Impact
MSK Authors
  1. Weiji Shi
    121 Shi
  2. David Amar
    125 Amar
  3. Peter Bach
    243 Bach
  4. Howard T Thaler
    242 Thaler
  5. Hao Zhang
    54 Zhang