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New-onset atrial fibrillation after coronary artery bypass grafting: risk prediction model

Authors: Kolesnikov V.N. 2, Ivanenko A.S. 1, Krasnov A.Yu. 2, Bulgakova N.E. 1, Kokorin V.A. 3, Yagoda A.V. 1, Boeva O.I. 1

Company: 1 Stavropol’ State Medical University of Ministry of Health of the Russian Federation, ulitsa Mira, 310, Stavropol’, 355017, Russian Federation;
2 Stavropol’ Regional Clinical Hospital, ulitsa Semashko, 1, Stavropol’, 355029, Russian Federation;
3 Pirogov Russian National Research Medical University of Ministry of Health of the Russian Federation, ulitsa Ostrovityanova, 1, Moscow, 117997, Russian Federation

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Type:  Heart rhythm disorders in patients with cardiac disease


DOI: https://doi.org/10.24022/1997-3187-2017-11-2-118-128

For citation: Kolesnikov V.N., Ivanenko A.S., Krasnov A.Yu., Bulgakova N.E., Kokorin V.A., Yagoda A.V., Boeva O.I. New-onset atrial fibrillation after coronary artery bypass grafting: risk prediction model. Kreativnaya kardiologiya (Creative Cardiology, Russian journal). 2017; 11 (2): 118—28 (in Russ.). DOI: http://dx.doi.org/10.24022/1997-3187-2017-11-2-118-128

Received / Accepted:  June 05, 2017 / June 16, 2017

Keywords: coronary artery bypass grafting new-onset atrial fibrillation risk factors predicting model

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Abstract

Objective. New-onset postoperative atrial fibrillation (POAF) is the most common complication following coronary artery bypass grafting (CABG). The aim was to investigate the new approach to predicting of new-onset POAF following CABG on-pump.

Material and methods. 200 patients aged 43—72 (mean age 59.8±5.9 years; 85.5% males) without previous atrial fibrillation and with indications for CABG were enrolled into a cohort prospective observational study Results. POAF lasting more than 30 seconds, according to the 10-day Holter monitoring, occurred in 46 (23%) patients with its peak occurrence on 2—4 days of postoperative period; in 10 (21.7%) cases the AF recurred. Logistic regression analysis was used to identify strong independent risk factors for POAF and to develop prediction models. Model I (sensitivity 96.8%, specificity 91.3%) involved the following set of predictors, possessing statistical reliability 95% or more: III—IV functional class chronic heart failure, brain natriuretic peptide (NT-proBNP) concentration 200 pg/mL or more, left atrium size more than 4.0 cm, left ventricle end-diastolic size more than 5.6 cm, left ventricle ejection fraction less than 50% and duration of CABG more than 240 min. Model II (sensitivity 97.4%, specificity 89.1%) included age more than 55 years, history of myocardial infarction or cardiac arrhythmias, left atrium size more than 4.0 cm, off-pump surgery time more than 100 min and total CABG time more than 240 min. Statistical significance of the models by X2 criterion — p<0.0001.

Conclusion. Logistic regressive models, based on available preoperative clinical symptoms and surgery duration, possessed high ability to predict the new-onset atrial fibrillation in the early period after CABG in patients with various degree myocardial remodeling and systolic dysfunction.

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About Authors

  • Kolesnikov Vladimir Nikolaevich, Cardiac Surgeon;
  • Ivanenko Anna Sergeevna, Postgraduate;
  • Krasnov Anton Yur’evich, Cardiac Surgeon;
  • Bulgakova Natal’ya Evgen’evna, Assistant Professor;
  • Kokorin Valentin Aleksandrovich, Cand. Med. Sc., Associate Professor;
  • Yagoda Aleksandr Valentinovich, Dr Med. Sc., Professor, Chief of Chair;
  • Boeva Ol’ga Igorevna, Dr Med. Sc., Associate Professor, Chief of Chair

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


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