Predicting New-Onset Postoperative Atrial Fibrillation Following Isolated Coronary Artery Bypass Grafting: Development and Validation of a Novel Nomogram

Kangjun Fan, Liang Chen*, Fei Liu, Xiaohang Ding, Pengyun Yan, Mingxin Gao, Wenyuan Yu, Hongli Liu, Yang Yu

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To select variables associated with new-onset postoperative atrial fibrillation (POAF) following isolated coronary artery bypass grafting (CABG) and develop a nomogram for risk prediction in a Chinese population.

Methods: The study retrospectively enrolled 4854 consecutive patients undergoing isolated CABG from February 2018 to September 2019, they were divided into derivation cohort and validation cohort with a 3:1 ratio according to the order of operation date. In the derivation cohort, significant variables were selected by use of the multivariate logistic backward stepwise regression analysis and a nomogram model was built on the strength of the results. The model performance was assessed in terms of discrimination and calibration. Besides, we compared the discriminative ability for POAF of the nomogram with established prediction models (CHA2DS2-VASc and HATCH scores) in the two cohorts.

Results: POAF occurred in 1025 (28.2%) out of 3641 patients in the derivation cohort, and in 337 (27.8%) out of 1213 patients in the validation cohort. A nomogram, composed of eight prognostic variables, namely age, sex, heart rate, hypertension, left ventricular ejection fraction (LVEF) < 50%, left atrial diameter (LAD) > 40mm, estimated glomerular filtration rate (eGFR) level, and on-pump surgery, was constructed from the derivation cohort. The nomogram had substantial discriminative ability in derivation and validation cohorts with the area under the receiver operating characteristic curves (AUCs) of 0.661 (95% confidence interval, 0.642– 0.681) and 0.665 (95% confidence interval, 0.631– 0.699), respectively, and showed well-fitted calibration curves. Compared with CHA2DS2-VASc, HATCH and POAF scores, respectively, the nomogram had superior discrimination performance.

Conclusion: We constructed a novel nomogram with improved accuracy for predicting the risk of POAF following isolated CABG, which might help clinicians predict individual probability of POAF and achieve effective prophylaxis.
Original languageEnglish
Pages (from-to)937-948
Number of pages12
JournalInternational Journal of General Medicine
Volume15
DOIs
Publication statusPublished - 26 Jan 2022

Scopus Subject Areas

  • Medicine(all)

User-Defined Keywords

  • Atrial fibrillation
  • Coronary artery bypass grafting
  • High-risk patients
  • Nomogram
  • Prediction

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