Clinical utility of CHADS2 and CHA2DS2-VASc scoring systems for predicting postoperative atrial fibrillation after cardiac surgery.
OBJECTIVES
The presence of postoperative atrial fibrillation predicts a higher short- and long-term mortality rates; however, no scoring system has been used to discriminate patients at high risk for this complication. The aim of this study was to investigate whether the CHADS2 and CHA2DS2-VASc scores are useful risk assessment tools for new-onset atrial fibrillation after cardiac surgery.


METHODS
A total of 277 consecutive patients who underwent cardiac surgery were prospectively included in this risk stratification study. We calculated the CHADS2 and CHA2DS2-VASc scores from the data collected. The primary end point was the development of postoperative atrial fibrillation within 30 days after cardiac surgery.


RESULTS
Eighty-four (30%) of the patients had postoperative atrial fibrillation at a median of 2 days (range, 0-27 days) after cardiac surgery. The CHADS2 and CHA2DS2-VASc scores were significant predictors of postoperative atrial fibrillation in separate multivariate regression analyses. The Kaplan-Meier analysis obtained a higher postoperative atrial fibrillation rate when based on the CHADS2 and CHA2DS2-VASc scores of at least 2 than when based on scores less than 2 (both log rank, P < .001). In addition, the CHA2DS2-VASc scores could be used to further stratify the patients with CHADS2 scores of 0 or 1 into 2 groups with different postoperative atrial fibrillation rates at a cutoff value of 2 (12% vs 32%; P = .01).


CONCLUSIONS
CHADS2 and CHA2DS2-VASc scores were predictive of postoperative atrial fibrillation after cardiac surgery and may be helpful for identifying high-risk patients.
['Chua|Su-Kiat|SK|', 'Shyu|Kou-Gi|KG|', 'Lu|Ming-Jen|MJ|', 'Lien|Li-Ming|LM|', 'Lin|Chia-Hsun|CH|', 'Chao|Hung-Hsing|HH|', 'Lo|Huey-Ming|HM|']
D000368:Aged D001281:Atrial Fibrillation D006348:Cardiac Surgical Procedures D016009:Chi-Square Distribution D003661:Decision Support Techniques D005260:Female D006801:Humans D053208:Kaplan-Meier Estimate D016015:Logistic Models D008297:Male D008875:Middle Aged D015999:Multivariate Analysis D016017:Odds Ratio D018579:Patient Selection D011446:Prospective Studies D018570:Risk Assessment D012307:Risk Factors D013997:Time Factors D016896:Treatment Outcome
postoperative atrial fibrillation atrial fibrillation OR 23.1 24 AF CABG CI E LV LVEDD LVM PAD POAF PWTD SWTD TIA confidence interval coronary artery bypass grafting early mitral inflow velocity e′ interventricular septal wall thickness left ventricular left ventricular end-diastolic diameter left ventricular mass medial mitral annular velocity during passive filling odds ratio peripheral arterial disease posterior wall thickness transient ischemic attack