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:BackgroundPostoperative atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery. While thyroid dysfunction can predict POAF, the association between preoperative serum free triiodothyronine (FT3) levels and POAF in patients undergoing off-pump coronary artery bypass (OPCAB) grafting remains unclear. This study aimed to investigate the relationship between preoperative FT3 levels and POAF in OPCAB patients.MethodsThis prospective observational study included patients with sinus rhythm and no history of atrial fibrillation or thyroid disease who underwent OPCAB and FT3 testing at the Tianjin Chest Hospital from June 2021 to March 2023. The relationship between FT3 level and POAF was evaluated using restricted cubic spline. Cox proportional hazards regression models were used to analyze the associations between FT3 concentration categories [low T3 syndrome (LT3S) (FT3 below the normal range), low normal FT3 (3.10-4.59 pmol/L), high normal FT3 (4.60-6.80 pmol/L)] and POAF, adjusting for potential confounders. Stratified analyses were performed to assess effect modification by gender and age (<60 vs. ≥60 years old).ResultsAmong 875 patients, 259 (29.6%) developed POAF within 2 days after surgery. Restricted cubic spline analysis showed an S-shaped association between FT3 concentration and POAF risk. Compared to the low normal FT3 group, LT3S was associated with an increased risk of POAF [hazard ratio (HR), 1.41; 95% confidence interval (CI): 1.90-2.19], while high normal FT3 was associated with a decreased risk (HR, 0.72; 95% CI: 0.51-0.99). The association between FT3 and increased POAF risk was more pronounced in patients aged ≥60 years (HR, 1.41; 95% CI: 1.89-2.22).ConclusionsPreoperative FT3 levels most likely could predict POAF risk after OPCAB, especially in patients aged 60 years and older. Measuring FT3 preoperatively may identify high-risk patients benefiting from close monitoring and prophylactic treatment. Further investigation of thyroid hormone replacement therapy for LT3S is warranted.

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.

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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