Background:Postoperative atrial fibrillation (PoAF) remains a significant risk factor for increased morbidity and mortality after cardiac surgery. The ability to accurately identify patients at risk through clinical risk factors is limited. There is growing evidence that polygenic risk contributes significantly to PoAF and incorporating measures of genetic risk could enhance prediction.Methods:A retrospective cohort study of 1047 patients of White European ancestry who underwent either coronary artery bypass grafting or valve surgery at a tertiary academic center and were free from a history or persistent preoperative atrial fibrillation. The primary outcome was defined as PoAF based on postoperative ECG reports, medical record documentation, and changes in medication. The exposure was a polygenic risk score (PRS) comprising 2746 single-nucleotide polymorphisms previously associated with atrial fibrillation risk. The prediction of PoAF risk was assessed using measures of model discrimination, calibration, and net reclassification improvement.Results:A total of 259 patients (24.7%) developed PoAF. The PRS was significantly associated with a higher risk for PoAF (odds ratio, 1.63 per SD increase in PRS [95% CI, 1.41–1.90]). Addition of PRS to patient- and procedure-related predictors of PoAF significantly increased the C statistic from 0.742 to 0.782 (change in C statistic, 0.040 [95% CI, 0.021–0.060]) while maintaining good calibration. The addition of the PRS to patient- and procedure-related predictors of PoAF improved model fit (likelihood ratio test, P=2.8×10⁻¹⁵) and significantly improved measures of reclassification (net reclassification improvement, 0.158 [95% CI, 0.066–0.274]).Conclusions:The PRS for PoAF was associated with improved discrimination, calibration, and risk reclassification compared with conventional clinical predictors suggesting that a PoAF PRS may enhance risk prediction of PoAF in patients undergoing coronary artery bypass grafting or valve surgery.

中文翻译：

---

心脏手术后心房颤动多基因风险评分的预测准确性

背景：术后心房颤动（PoAF）仍然是心脏手术后发病率和死亡率增加的重要危险因素。通过临床风险因素准确识别处于风险中的患者的能力有限。越来越多的证据表明，多基因风险对 PoAF 有显着影响，纳入遗传风险测量可以增强预测。方法：一项回顾性队列研究对 1047 名在三级学术中心接受冠状动脉旁路移植术或瓣膜手术的欧洲白人血统的患者进行无病史或术前持续性房颤。根据术后心电图报告、医疗记录文件和药物变化，将主要结果定义为 PoAF。暴露是一个多基因风险评分（PRS），包括以前与心房颤动风险相关的 2746 个单核苷酸多态性。使用模型辨别、校准和净重分类改进的措施评估 PoAF 风险的预测。结果：共有 259 名患者 (24.7%) 发展为 PoAF。PRS 与更高的 PoAF 风险显着相关（比值比，PRS 中每 SD 增加 1.63 [95% CI，1.41-1.90]）。将 PRS 添加到与患者和手术相关的 PoAF 预测因子显着增加 C 统计量从 0.742 到 0.782（C 统计量变化，0.040 [95% CI，0.021-0.060]），同时保持良好的校准。将 PRS 添加到与患者和手术相关的 PoAF 预测因子改善了模型拟合（似然比检验，结果：共有 259 名患者 (24.7%) 发生了 PoAF。PRS 与更高的 PoAF 风险显着相关（比值比，PRS 中每 SD 增加 1.63 [95% CI，1.41-1.90]）。将 PRS 添加到与患者和手术相关的 PoAF 预测因子显着增加 C 统计量从 0.742 到 0.782（C 统计量变化，0.040 [95% CI，0.021-0.060]），同时保持良好的校准。将 PRS 添加到与患者和手术相关的 PoAF 预测因子改善了模型拟合（似然比检验，结果：共有 259 名患者 (24.7%) 发生了 PoAF。PRS 与更高的 PoAF 风险显着相关（比值比，PRS 中每 SD 增加 1.63 [95% CI，1.41-1.90]）。将 PRS 添加到与患者和手术相关的 PoAF 预测因子显着增加 C 统计量从 0.742 到 0.782（C 统计量变化，0.040 [95% CI，0.021-0.060]），同时保持良好的校准。将 PRS 添加到与患者和手术相关的 PoAF 预测因子改善了模型拟合（似然比检验，0.040 [95% CI, 0.021–0.060])，同时保持良好的校准。将 PRS 添加到与患者和手术相关的 PoAF 预测因子改善了模型拟合（似然比检验，0.040 [95% CI, 0.021–0.060])，同时保持良好的校准。将 PRS 添加到与患者和手术相关的 PoAF 预测因子改善了模型拟合（似然比检验，P = 2.8×10 ^-15 ) 并显着改善了重新分类的措施（净重新分类改善，0.158 [95% CI，0.066–0.274]）。传统的临床预测指标表明，PoAF PRS 可以增强接受冠状动脉旁路移植术或瓣膜手术的患者对 PoAF 的风险预测。