Are CHADS2 and CHA2DS2-VASc scoring systems useful for predicting postoperative atrial fibrillation after coronary artery bypass graft surgery?

Abstract

Introduction: In recent literature, limited data exist whether the CHADS2 and CHA2DS2-VASc scores can be used for the prediction of new-onset atrial fibrillation (AF) or AF after coronary artery bypass graft (CABG) surgery.Patients and Methods: We retrospectively analyzed 133 consecutive patients (42 patients with AF and 91 patients without AF) who were undergoing CABG between at our department. Complete medical records were retrospectively collected to investigate CHADS2 and CHA2DS2-VASc scores. The primary end point of this study was the development of AF after CABG surgery.Results: Only age (67.6+9.7 vs 62.4+10.6 years, p=0.008) was significantly higher in AF group. Mean CHADS2 and CHA2DS2-VASc scores were 1.53+0.97 and 3.23+1.25 respectively. CHADS2 (1.62+0.91 vs 1.48+1.00, p=0.34) and CHA2DS2-VASc (3.43+1.17 vs 3.13+1.28, p=0.22) scores were higher in AF group but it was not statistically significant. When patients divided into two groups according to CHADS2 and CHA2DS2-VASc scores at the cuttof point of 2, no significant difference was detected in AF rate (31.9% vs 30.0%, p=0.55 and 34.4% vs 24.3%, p=0.18 respectively). In univariate and multivariate analysis only age was independent predictor of AF after CABG surgery.Conclusion: CHADS2 and CHA2DS2-VASc scores are not independent predictors of AF after CABG surgery.

Keywords

• atrial fibrillation, CHADS2 score, CHA2DS2-VASc, coronary artery bypass graft surgery

CHADS2 ve CHA2DS2-VASc Skorları Koroner Arter Bypas Cerrahisi Sonrası Gelişen Atriyal Fibrilasyonunun Öngördürücüsü müdür?

Abstract

Giriş: Literatürde yeni başlayan atrial fibrilasyon (AF) ya da koroner arter bypas greft (KABG) cerrahisi sonrası gelişen AF'yi öngörmede CHADS2 ve CHA2DS2-VASc skorlarının kullanımı ile ilgili sınırlı sayıda veri mevcuttur.Hastalar ve Yöntem: Merkezimizde KABG cerrahisi yapılan 133 ardışık hasta (42 hasta AF ve AF olmayan 91 hasta) retrospektif olarak incelendi. Hastaların CHADS2 ve CHA2DS2-VASc skor kayıtları incelendi. Bu çalışmanın birincil sonlanım noktası hastane içinde KABG cerrahisi sonrası AF gelişmesiydi.Bulgular: AF grubunda sadece yaş anlamlı olarak yüksek idi (67.6+9.7'ye karşı 62.4+10.6 yıl, p=0.008). Sırasıyla ortalama CHADS2 ve CHA2DS2-VASc skorları 1.53+0.97 ve 3.23+1.25 idi. CHADS2 (1.62+0.91'ye karşı 1.48+1.00, p=0.34) ve CHA2DS2-VASc skorları (3.43+1.17'ye karşı 3.13+1.28, p=0.22) AF grubunda yüksek olmasına rağmen istatistiksel olarak anlamlı değildi. Hastalar CHADS2 ve CHA2DS2-VASc skorları 2 sınır değeri alınıp karşılaştırıldığında AF oranları arasında fark saptanmadı (%31.9'ye karşı %30.0, p=0.55 ve %34.4'ye karşı %24.3, p=0.18). Tek değişkenli ve çok değişkenli analizde sadece yaş KABG cerrahisi sonrası AF'nin öngördürücüsüydü.Sonuç: CHADS2 ve CHA2DS2-VASc skorları KABG cerrahisi sonrası gelişen AF'nin öngördürücüsü değildir.

Keywords

• atrial fibrilasyon, CHADS2 skoru, CHA2DS2-VASc, koroner arter bypas greft

References

1. Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 2001;285:2864-70.
2. Lip GY, Frison L, Halperin JL, Lane DA. Identifying patients at high risk for stroke despite anticoagulation: a comparison of contemporary stroke risk stratification schemes in an anticoagulated atrial fibrillation cohort. Stroke 2010;41:2731-8.
3. Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an updateof the 2010 ESC Guidelines for the management of atrial fibrillation--developed with the special contribution of the European Heart Rhythm Association. Europace 2012;14:1385-413.
4. Gungor H, Ayik MF, Kirilmaz B, Ertugay S, Gul I, Yildiz BS, et al. Serum resistin level: as a predictor of atrial fibrillation after coronary artery bypass graft surgery. Coron Artery Dis 2011;22:484-90.
5. Patel D, Gillinov MA, Natale A. Atrial fibrillation after cardiac surgery: where are we now? Indian Pacing Electrophysiol J 2008;8:281-91.
6. Mathew JP, Fontes ML, Tudor IC, Ramsay J, Duke P, Mazer CD, et al. A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA 2004;291:1720-9.
7. Maisel WH, Rawn JD, Stevenson WG. Atrial fibrillation after cardiac surgery. Ann Intern Med 2001;135:1061-73.
8. Magee MJ, Herbert MA, Dewey TM, Edgerton JR, Ryan WH, Prince S, et al. Atrial fibrillation after coronary artery by-pass grafting surgery: development of a predictive risk algorithm. Ann Thorac Surg 2007;83:1707-12.

9. Chua SK, Shyu KG, Lu MJ, Lien LM, Lin CH, Chao HH, et al. Clinical utility of CHADS2 and CHA2DS2-VASc scoring systems for predicting postoperative atrialfibrillation aftercardiac surgery. J Thorac Cardiovasc Surg 2013;146:919-26.
10. Sareh S, Toppen W, Mukdad L, Satou N, Shemin R, Buch E, et al. CHADS2 score predicts atrial fibrillation following cardiac surgery. J Surg Res 2014;15:151-6.
11. Stafford PJ, Kolvekar S, Cooper J, Fothergill J, Schlindwein F, deBono DP, et al. Signal-averaged P-wave compared with standard electrocardiography or echocardiography for prediction of atrial fibrillation after coronary bypass grafting. Heart 1997;77:417-22.
12. Passman R, Beshai J, Pavri B, Kimmel S. Predicting post-coronary bypass surgery atrial arrhythmias from the pre-operative ECG. Am Heart J 2001;142:806-10.
13. Schmitt J, Duray G, Gersh BJ, Hohnloser SH. Atrial fibrillation in acute myocardial infarction: a systematic review of the incidence, clinical features and prognostic implications. Eur Heart J 2009;30:1038-45.
14. Osranek M, Fatema K, Qaddoura F, Al-Saileek A, Barnes ME, Bailey KR, et al. Left atrial volume predicts the risk of atrial fibrillation after cardiac surgery. JACC 2006;48:779-86.
15. Rosiak M, Dziuba M, Chudzik M, Cygankiewicz I, Bartczak K, Drozdz J, et al. Risk factors for atrial fibrillation: Not always severe heart disease, not always so ‘lonely’. Cardiol J 2010;17:437-42.
16. Movahed MR, Hashemzadeh M, Jamal MM. Diabetes mellitus is a strong, independent risk for atrial fibrillation and flutter in addition to other cardiovascular disease. Int J Cardiol 2005;105:315-8.
17. Schnabel RB, Sullivan LM, Levy D, Pencina MJ, Massaro JM, D’Agostino RB Sr, et al. Development of a riskscore for atrial fibrillation (Framingham Heart Study): A community-based cohort study. Lancet 2009;373:739-45.
18. Aksnes TA, Schmieder RE, Kjeldsen SE, Ghani S, Hua TA, Julius S. Impact of new-onset diabetes mellitus on development of atrial fibrillation and heart failure in high-risk hypertension (from the VALUE Trial). Am J Cardiol 2008;101:634-8
19. Crijns HJ, Tjeerdsma G, de Kam PJ, Boomsma F, van Gelder IC, van den Berg MP, et al. Prognostic value of the presence and development of atrial fibrillation in patients with advanced chronic heart failure. Eur Heart J 2000;21:1238-45.
20. Levy S. Atrial fibrillation, the arrhythmia of the elderly, causes and associated conditions. Anadolu Kardiyol Derg 2002;2:55-60.
21. Levy S. Factors predisposing to the development of atrial fibrillation. Pacing Clin Electrophysiol 1997;20:2670-4.