Document Detail


Atrial fibrillation after coronary artery bypass grafting surgery: development of a predictive risk algorithm.
MedLine Citation:
PMID:  17462385     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Atrial fibrillation is a costly complication occurring in 15% to 40% of patients after coronary artery bypass grafting (CABG). Aggressive prophylactic treatment should be directed toward and limited to selected high-risk patients. Utilizing perioperative risk factors, we sought to develop an algorithm to predict the relative risk of developing postoperative atrial fibrillation in patients undergoing CABG. METHODS: Data were extracted from our Society of Thoracic Surgeons Database on 19,620 patients undergoing CABG between January 1995 and July 2006. We used perioperative risk factors to develop a logistic regression equation predictive for the development of postoperative atrial fibrillation. A total of 19,083 patients had complete data and were used to construct the final model. The model was used to compare the predicted probability of atrial fibrillation with the known outcome in the patients divided into deciles by probability. Bootstrap procedures were used to determine the confidence limits of the beta coefficients. RESULTS: A regression model was developed with 14 significant indicators. Those showing the greatest predictive influence included the patient age, the need for prolonged ventilation (24 hours or more), the use of cardiopulmonary bypass, and preoperative arrhythmias. The model showed acceptable concordance between observed and predicted (72.3%), a receiver operating characteristic curve area of 0.72, and Hosmer-Lemeshow probability of 0.19. When applied to the patient population, the calculated risk in those who did not develop AF was 0.179 +/- 0.116 and for those with AF, 0.284 +/- 0.153 (p < 0.001). CONCLUSIONS: A validated predictive risk algorithm for developing postoperative atrial fibrillation can reliably stratify patients undergoing CABG into high-risk and low-risk groups. This may be used preoperatively to appropriately target high-risk patients for aggressive prophylactic treatment.
Authors:
Mitchell J Magee; Morley A Herbert; Todd M Dewey; James R Edgerton; William H Ryan; Syma Prince; Michael J Mack
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  83     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2007 May 
Date Detail:
Created Date:  2007-04-27     Completed Date:  2007-05-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1707-12; discussion 1712     Citation Subset:  AIM; IM    
Affiliation:
Medical City Dallas Hospital, Dallas, Texas 75230, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Algorithms
Atrial Fibrillation / epidemiology*,  etiology
Coronary Artery Bypass / adverse effects*
Female
Humans
Logistic Models
Male
Middle Aged
Models, Biological
Models, Statistical
Retrospective Studies
Risk Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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