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Renal dysfunction and the risk of postoperative atrial fibrillation after cardiac surgery: role beyond the CHA2DS2-VASc score
- Source :
- Europace. 17:1363-1370
- Publication Year :
- 2015
- Publisher :
- Oxford University Press (OUP), 2015.
-
Abstract
- Aims To investigate whether renal dysfunction is a useful predictor of postoperative atrial fibrillation (POAF) after cardiac surgery. We also aimed to determine whether the addition of renal dysfunction into the scoring system could improve diagnostic accuracy of the CHA2DS2-VASc score to predict POAF. Methods and results The study prospectively enrolled 350 consecutive patients who underwent cardiac surgery. Echocardiography was performed before cardiac surgery. Renal dysfunction was defined as estimated glomerular filtration rate < 60 mL min−1 1.73 m−2. All patients were monitored with continuous electrocardiographic telemetry for the occurrence of POAF until the day of hospital dismissal. Postoperative atrial fibrillation occurred in 103 of 350 patients (29%). Patients with POAF was associated with longer intensive care unit stay compared with those without POAF (3.7 ± 2.2 vs. 3.1 ± 1.4 days, P = 0.002). Both the CHA2DS2-VASc score and renal dysfunction were independent predictors of POAF in multivariate analysis. Renal dysfunction can further stratify patients with a CHA2DS2-VASc score of 0 or 1 into two groups with different POAF rates (3.1% vs. 68.8%, P < 0.001). A new scoring system (R-CHA2DS2-VASc score) derived by assigning an additional point representing renal dysfunction to the CHA2DS2-VASc score could improve its predictive accuracy. The area under the receiver operating characteristic curve increased from 0.68 to 0.71 ( P < 0.001). Furthermore, the rate of left ventricular diastolic dysfunction also increased with increasing renal dysfunction. Conclusion Renal dysfunction, associated with left ventricular diastolic dysfunction, was a significant risk factor for POAF after cardiac surgery and may improve the diagnostic accuracy of the CHA2DS2-VASc score.
- Subjects :
- Male
medicine.medical_specialty
Multivariate analysis
Renal function
Kaplan-Meier Estimate
Kidney
Risk Assessment
law.invention
Postoperative Complications
Predictive Value of Tests
Risk Factors
law
Physiology (medical)
Internal medicine
Atrial Fibrillation
medicine
Humans
Prospective Studies
Cardiac Surgical Procedures
Aged
Receiver operating characteristic
business.industry
Atrial fibrillation
Middle Aged
medicine.disease
Intensive care unit
Cardiac surgery
ROC Curve
Echocardiography
Multivariate Analysis
CHA2DS2–VASc score
Cardiology
Female
Left ventricular diastolic dysfunction
Cardiology and Cardiovascular Medicine
business
Glomerular Filtration Rate
Subjects
Details
- ISSN :
- 15322092 and 10995129
- Volume :
- 17
- Database :
- OpenAIRE
- Journal :
- Europace
- Accession number :
- edsair.doi.dedup.....99e62c25713a61ff903c5c65cff17a00