Clinical prediction rule for atrial fibrillation after coronary artery bypass grafting.
OBJECTIVE
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.


BACKGROUND
Reported prediction rules for postoperative AF have suffered from inconsistent results and controversy surrounding the added predictive value of a prolonged P-wave duration.


METHODS
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.


RESULTS
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 >or=80 points, 117 of 199 (59%). The area under the receiver-operator characteristic curve for the model was 0.69.


CONCLUSIONS
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.
Amar
David
D
Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University, New York, New York 10021, USA. amard@mskcc.org
Shi
Weiji
W
Hogue
Charles W
CW
Zhang
Hao
H
Passman
Rod S
RS
Thomas
Betsy
B
Bach
Peter B
PB
Damiano
Ralph
R
Thaler
Howard T
HT
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000209:etiology*; D001282:Atrial Flutter / Q000188:drug therapy / Q000209:etiology; D002303:Cardiac Output, Low / Q000188:drug therapy / Q000209:etiology; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology*; D011237:Predictive Value of Tests; D012372:ROC Curve; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists