Dataset Information

Preoperative P-wave duration as a predictor of atrial fibrillation after coronary artery bypass grafting: A prospective cohort study with meta-analysis.

ABSTRACT:

Objectives

Reported prediction rules for postoperative atrial fibrillation (AF) have suffered from inconsistent results and controversy surrounding the predictive value of a preoperative P-wave duration (PreOPWD). This study examined PreOPWD as a predictor for AF after coronary artery bypass grafting (CABG).

Methods

Two-hundred-and-ninety-nine patients with sinus rhythm before off-pump CABG were recruited into the study. Patients' demographic and clinical data were evaluated prospectively. Patients were continuously monitored for the first seven postoperative days. Multiple logistic regression was used to determine significant predictors of AF. Findings were then combined with similar studies and a meta-analysis was performed.

Results

Postoperative AF was observed in 33.1% of 299 patients. Patients with AF were older, had a prolonged PreOPWD, higher incidences of hypertension, aortic regurgitation, and mitral regurgitation. A cut-off point of PreOPWD?105?ms achieved a specificity of 74%, and a sensitivity of 65% for predictive of AF. Multivariate analysis showed that PreOPWD?105?ms (odds ratio [OR] 4.63, 95% confidence intervals [CI] 2.66 to 8.03, P?OR 2.72, 95% CI 1.51 to 4.90, P?OR 2.10, 95% CI 1.08 to 4.07, P?CI 1.97 to 5.92, P?ConclusionThis study confirmed, among other predictive characteristics, that PreOPWD is a powerful independent predictor of POAF.

SUBMITTER: Wu F

PROVIDER: S-EPMC6626247 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

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Publications

Preoperative P-wave duration as a predictor of atrial fibrillation after coronary artery bypass grafting: A prospective cohort study with meta-analysis.

Wu Fangqin F Wu Ying Y Tao Wenyan W Zhao Haibo H Shen Dongyan D

International journal of nursing sciences 20180414 2

<h4>Objectives</h4>Reported prediction rules for postoperative atrial fibrillation (AF) have suffered from inconsistent results and controversy surrounding the predictive value of a preoperative P-wave duration (PreOPWD). This study examined PreOPWD as a predictor for AF after coronary artery bypass grafting (CABG).<h4>Methods</h4>Two-hundred-and-ninety-nine patients with sinus rhythm before off-pump CABG were recruited into the study. Patients' demographic and clinical data were evaluated prosp ...[more]

PMID: 31406817

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Project description:Background The CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, previous stroke or TIA [transient ischemic attack], vascular disease, age 65 to 74 years, sex category female; 2 indicates 2 points, otherwise 1 point) scoring system is recommended to guide decisions on oral anticoagulation therapy for stroke prevention in patients with nonsurgery atrial fibrillation. A score ≥1 in men and ≥2 in women, corresponding to an annual stroke risk exceeding 1%, warrants long-term oral anticoagulation provided the bleeding risk is acceptable. However, in patients with new-onset postoperative atrial fibrillation, the optimal risk stratification method is unknown. The aim of this study was therefore to evaluate the CHA2DS2-VASc scoring system for estimating the 1-year ischemic stroke risk in patients with new-onset postoperative atrial fibrillation after coronary artery bypass grafting. Methods and Results All patients with new-onset postoperative atrial fibrillation and without oral anticoagulation after first-time isolated coronary artery bypass grafting performed in Sweden during 2007 to 2017 were eligible for this registry-based observational cohort study. The 1-year ischemic stroke rate at each step of the CHA2DS2-VASc score was estimated using a Kaplan-Meier estimator. Of the 6368 patients included (mean age, 69.9 years; 81% men), >97% were treated with antiplatelet drugs. There were 147 ischemic strokes during the first year of follow-up. The ischemic stroke rate at 1 year was 0.3%, 0.7%, and 1.5% in patients with CHA2DS2-VASc scores of 1, 2, and 3, respectively, and ≥2.3% in patients with a score ≥4. A sensitivity analysis, with the inclusion of patients on anticoagulants, was performed and supported the primary results. Conclusions Patients with new-onset atrial fibrillation after coronary artery bypass grafting and a CHA2DS2-VASc score <3 have such a low 1-year risk for ischemic stroke that oral anticoagulation therapy should probably be avoided.

Project description:Pre- and postconditioning describe mechanisms whereby short ischemic periods protect an organ against a longer period of ischemia. Interestingly, short ischemic periods of a limb, in itself harmless, may increase the ischemia tolerance of remote organs, e.g. the heart (remote conditioning, RC). Although several studies have shown reduced biomarker release by RC, a reduction of complications and improvement of patient outcome still has to be demonstrated. Atrial fibrillation (AF) is one of the most common complications after coronary artery bypass graft surgery (CABG), affecting 27-46% of patients. It is associated with increased mortality, adverse cardiovascular events, and prolonged in-hospital stay. We hypothesize that remote ischemic pre- and/or post-conditioning reduce the incidence of AF following CABG, and improve patient outcome.This study is a randomized, controlled, patient and investigator blinded multicenter trial. Elective CABG patients are randomized to one of the following four groups: 1) control, 2) remote ischemic preconditioning, 3) remote ischemic postconditioning, or 4) remote ischemic pre- and postconditioning. Remote conditioning is applied at the arm by 3 cycles of 5 minutes of ischemia and reperfusion. Primary endpoint is the incidence AF in the first 72 hours after surgery, detected using a Holter-monitor. Secondary endpoints include length-of-stay on the intensive care unit and in-hospital, and the occurrence of major adverse cardiovascular events at 30 days, 3 months and 1 year.Based on an expected incidence in the control group of 27%, 195 patients per group are needed to detect with 80% power a reduction by 45% following either pre- or postconditioning, while allowing for a 10% dropout and at an alpha of 0.05. With the combined intervention expected to be stronger, we need 75 patients in this group to detect a reduction in incidence of AF of 60%.The RICO-trial (the effect of Remote Ischemic Conditioning on atrial fibrillation and Outcome) is a randomized controlled multicenter trial, designed to investigate whether remote ischemic pre- and/or post-conditioning of the arm reduce the incidence of AF following CABG surgery.ClinicalTrials.gov under NCT01107184.

Dataset Information

Preoperative P-wave duration as a predictor of atrial fibrillation after coronary artery bypass grafting: A prospective cohort study with meta-analysis.

Objectives

Methods

Results

Publications

Preoperative P-wave duration as a predictor of atrial fibrillation after coronary artery bypass grafting: A prospective cohort study with meta-analysis.

Similar Datasets

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