Background

Postoperative atrial fibrillation (POAF) is associated with an increased risk of short and long-term stroke. Our aim is to identify the independent predictors of cerebrovascular accident (CVA) development in the patients who underwent isolated coronary artery bypass graft (CABG) surgery and developed POAF which lasted within 48 h.

Method

301 consecutive patients who underwent isolated CABG surgery in our institution between January 2015 and September 2019 and developed POAF which lasted within 48 h, were retrospectively analyzed. Oral anticoagulant (OAC) treatment was not started in any of these patients, and those who received OAC during follow-ups, were excluded from the study. The predictors of CVA development after mean 32.1± 17.9 months follow-up, were determined by using the Cox proportional hazards model.

Results

20 (6.6%) patients developed CVA, in which 6 (2.0%) of them were in-hospital events. As a result of the multivariate analysis, being over 70 year-old, history of CVA, hypertension (HT), and left ventricular ejection fraction (LVEF) < 45% were determined as the independent predictors of CVA development over time. Having at least two of these factors could predict CVA development with sensitivity of 95.0% and specificity of 82.2%. This predictive value was better than the value obtained with CHA₂DS₂-VASc score.

Conclusion

The risk factors which we have obtained, might be used to evaluate the risk of CVA development over time in the patients who underwent isolated CABG surgery and developed POAF which lasted within 48 h.

中文翻译：

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冠状动脉搭桥手术后新发房颤患者脑血管意​​外预测指标的确定

背景

术后房颤（POAF）与短期和长期中风的风险增加相关。我们的目的是确定接受独立冠状动脉搭桥术（CABG）并发展了持续48小时的POAF的患者中脑血管意外（CVA）发生的独立预测因素。

方法

回顾性分析2015年1月至2019年9月间在本院接受CABG孤立手术并持续48小时的POAF的301例患者。这些患者均未开始口服抗凝剂（OAC）治疗，并且在随访期间接受OAC的患者被排除在研究范围之外。使用Cox比例风险模型确定平均32.1±17.9个月的随访后CVA发生的预测指标。

结果

20例（6.6％）患者发生了CVA，其中6例（2.0％）是住院事件。作为多变量分析的结果，年龄超过70岁的患者，其CVA病史，高血压（HT）和左心室射血分数（LVEF）<45％被确定为CVA随着时间发展的独立预测因子。这些因素中至少有两个可以预测CVA的发展，其敏感性为95.0％，特异性为82.2％。该预测值比用CHA ₂ DS ₂ -VASc得分获得的值更好。

结论

我们获得的危险因素可用于评估接受孤立CABG手术并发展为持续48小时的POAF的患者随着时间推移CVA发生的风险。