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Predictive ability of perioperative atrial fibrillation risk indices in cardiac surgery patients: a retrospective cohort study.

Publication ,  Journal Article
Waldron, NH; Cooter, M; Piccini, JP; Anstrom, KJ; Klinger, RY; Kertai, MD; Podgoreanu, MV; Stafford-Smith, M; Newman, MF; Mathew, JP
Published in: Can J Anaesth
July 2018

PURPOSE: The Multicenter Study of Perioperative Ischemia (McSPI) AFRisk index predicts postoperative atrial fibrillation (POAF) after cardiac surgery, but requires pre-, intra-, and postoperative data. Other more abbreviated risk indices exist, but there is no consensus on which risk index is optimal. We compared the discriminatory capacity of the McSPI AFRisk index with three indices containing only preoperative data (the CHA2DS2Vasc score, POAF score, and Kolek clinical risk prediction model), hypothesizing that the McSPI AFRisk index would have superior predictive capacity. METHODS: We retrospectively evaluated 783 patients undergoing cardiac surgery using cardiopulmonary bypass. The predictive capacity of each index was assessed by comparing receiver-operating characteristic (ROC) curves, scaled Brier scores, net reclassification indices, and the integrated discrimination indices. RESULTS: The incidence of POAF was 32.6%. The area under the curve (AUC) of the ROC curve were 0.77, 0.58, 0.66, and 0.66 for the McSPI AFRisk index, CHA2DS2Vasc score, POAF score, and Kolek clinical risk prediction model, respectively. The McSPI AFRIsk index had the highest AUC (P < 0.0001). The scaled Brier scores for the McSPI AFRisk index, CHA2DS2Vasc score, POAF score, and Kolek clinical risk prediction model were 0.23, 0.02, 0.08, and 0.07, respectively. Both net reclassification indices and integrated discrimination indices showed that the McSPI AFRisk index more appropriately identified patients at high risk of POAF. CONCLUSIONS: The McSPI AFRisk index showed superior ability to predict POAF after cardiac surgery compared with three other indices. When clinicians and investigators wish to measure the risk of POAF after cardiac surgery, they should consider using the McSPI AFRisk index.

Duke Scholars

Published In

Can J Anaesth

DOI

EISSN

1496-8975

Publication Date

July 2018

Volume

65

Issue

7

Start / End Page

786 / 796

Location

United States

Related Subject Headings

  • Risk
  • Retrospective Studies
  • Postoperative Complications
  • Middle Aged
  • Male
  • Humans
  • Female
  • Cardiac Surgical Procedures
  • Atrial Fibrillation
  • Area Under Curve
 

Citation

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Waldron, N. H., Cooter, M., Piccini, J. P., Anstrom, K. J., Klinger, R. Y., Kertai, M. D., … Mathew, J. P. (2018). Predictive ability of perioperative atrial fibrillation risk indices in cardiac surgery patients: a retrospective cohort study. Can J Anaesth, 65(7), 786–796. https://doi.org/10.1007/s12630-018-1119-x
Waldron, Nathan H., Mary Cooter, Jonathan P. Piccini, Kevin J. Anstrom, Rebecca Y. Klinger, Miklos D. Kertai, Mihai V. Podgoreanu, Mark Stafford-Smith, Mark F. Newman, and Joseph P. Mathew. “Predictive ability of perioperative atrial fibrillation risk indices in cardiac surgery patients: a retrospective cohort study.Can J Anaesth 65, no. 7 (July 2018): 786–96. https://doi.org/10.1007/s12630-018-1119-x.
Waldron NH, Cooter M, Piccini JP, Anstrom KJ, Klinger RY, Kertai MD, et al. Predictive ability of perioperative atrial fibrillation risk indices in cardiac surgery patients: a retrospective cohort study. Can J Anaesth. 2018 Jul;65(7):786–96.
Waldron, Nathan H., et al. “Predictive ability of perioperative atrial fibrillation risk indices in cardiac surgery patients: a retrospective cohort study.Can J Anaesth, vol. 65, no. 7, July 2018, pp. 786–96. Pubmed, doi:10.1007/s12630-018-1119-x.
Waldron NH, Cooter M, Piccini JP, Anstrom KJ, Klinger RY, Kertai MD, Podgoreanu MV, Stafford-Smith M, Newman MF, Mathew JP. Predictive ability of perioperative atrial fibrillation risk indices in cardiac surgery patients: a retrospective cohort study. Can J Anaesth. 2018 Jul;65(7):786–796.
Journal cover image

Published In

Can J Anaesth

DOI

EISSN

1496-8975

Publication Date

July 2018

Volume

65

Issue

7

Start / End Page

786 / 796

Location

United States

Related Subject Headings

  • Risk
  • Retrospective Studies
  • Postoperative Complications
  • Middle Aged
  • Male
  • Humans
  • Female
  • Cardiac Surgical Procedures
  • Atrial Fibrillation
  • Area Under Curve