Development and validation of a diagnostic model based on left atrial diameter to predict postoperative atrial fibrillation after off-pump coronary artery bypass grafting

Abstract

Background This cohort study collected the clinical data of patients who underwent off-pump coronary artery bypass grafting (OPCABG) during hospitalization to observe the occurrence of postoperative atrial fibrillation (POAF), construct a POAF prediction model for CABG patients based on the left atrial diameter (LAD), and assist clinicians in making better medical decisions. Methods In this study, all patients who had no prior history of arrhythmia and who had received isolated OPCABG between May 1, 2021, and February 1, 2022, at Beijing Anzhen Hospital Affiliated to Capital Medical University (n=749) were reviewed. Depending on an optimal cutoff obtained from receiver operating characteristic (ROC) curve analysis, patients were separated into two groups: a group with POAF (n=188) and a group without POAF (n=561). The incidence of POAF was then compared. Prediction models were built, and nomograms were plotted was plotted. Model evaluation, including calibration curve and decision curve analysis, was performed. Results In all, 188 out of 749 (25.1%) patients who underwent cardiac surgery experienced POAF. Multifactorial logistic regression analysis showed that age ≥66 years, LAD ≥39 mm, and post-OPCABG atrial fibrillation (AF) were independently associated. The prognostic nomogram model showed good concordance index (C-index) scores. Decision curve analysis suggested the clinical benefit of the prediction models. Conclusions In this study, a prediction model for patients with POAF after OPCABG was assessed, which was shown to make more accurate predictions compared with the original risk prediction system. It may assist doctors to optimize management of patients with POAF.

Low-normal free triiodothyronine as a predictor of post-operative atrial fibrillation after surgical coronary revascularization

“…Age, post-operative laboratory parameters including BNP and LDH were significantly higher in the AF group compared with the non-AF group (all P<0.05). It was reported that LAD independently associated with AF following CABG ( 11 ). Consistently, the present study revealed that LAD was markedly bigger in the AF group (38.83±4.91 vs. 37.13±4.28 mm, P=0.001).…”

Predicting postoperative atrial fibrillation after off-pump coronary artery bypass surgery—an ongoing story

“…Zhang et al further explored the role of adding left atrial diameter to these existing predictive scores for AF post-cardiac surgery (CHA 2 DS 2 -VASc, POAF and HATCH). The authors found that the addition of left atrial diameter improved the predictive value of the POAF and HATCH scores but not the CHA 2 DS 2 -VASc score ( 8 ). With progressive left atrial dilatation, electrical remodelling of the left atrium leads to poor coordination of atrial contraction and the inability to maintain normal sinus rhythm.…”

“…The incidence of POAF in isolated coronary artery bypass grafting (CABG) ranges from 13–33% ( 1 - 5 ). In patients undergoing isolated off-pump coronary artery bypass grafting (OPCABG), the incidence of POAF ranges from 8–20% ( 1 , 2 , 6 - 8 ).…”

“…The recent study by Zhang et al should be commended on their efforts to evaluate the incidence and elucidate risk factors associated with POAF in 749 patients who underwent OPCABG ( 8 ). The authors report results from a high-volume centre over a 9-month period (1 May, 2021 to 1 Feb, 2022).…”

“…The recently published study by Zhang et al ( 8 ) contributes to the limited evidence regarding left atrial diameter as a predictor of POAF after OPCABG. It highlights the potential of incorporating the preoperative left atrial diameter, which is an easily derived echocardiographic parameter, to improve the performance of existing predictive scores for POAF.…”