Scores predicting atrial fibrillation after mitral valve surgery: Do we need a more specific score?

Monirah A. Albabtain, Elham A. Almathami, Haneen Alghosoon, Faisal F. Alsubaie, Ibrahim M. Abdelaal, Huda H. Ismail, Adam I. Adam, Amr A. Arafat
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Abstract

Atrial fibrillation after cardiac surgery (POAF) is associated with increased morbidity and mortality. Several scores were used to predict POAF, with variable results. Thus, this study assessed the performance of several scoring systems to predict POAF after mitral valve surgery. Additionally, we identified the risk factors for POAF in those patients.This retrospective cohort included 1381 recruited from 2009 to 2021. The patients underwent mitral valve surgery, and POAF occurred in 233 (16.87%) patients. The performance of CHADS2, CHA2DS2‐VASc, POAF, EuroSCORE II, and HATCH scores was evaluated.The median age was higher in patients who developed POAF (60 vs. 54 years; p < .001). CHA2‐DS2‐VASc, POAF, EuroSCORE II, and HATCH scores significantly predicted POAF, with areas under the curve of the receiver operator curve (AUCROC) of 0.56, 0.61, 0.58, and 0.54, respectively. We identified age > 58 years, body mass index > 28 kg/m2, creatinine clearance < 90 mL/min, reoperative surgery, and preoperative inotropic and intra‐aortic balloon pump use as predictors of POAF. We constructed a score from these variables (PSCC‐AF). A score > 2 significantly predicted POAF (p < .001). The AUCROC of this score was 0.67, which was significantly higher than the AUCROC of the POAF score (p = .009).POAF after mitral valve surgery can be predicted based on preoperative patient characteristics. The new PSCC‐AF score significantly predicted POAF after mitral valve surgery and can serve as a bedside diagnostic tool for POAF risk screening. Further studies are needed to validate the PSCC‐AF‐mitral score externally.
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预测二尖瓣手术后心房颤动的评分:我们需要更具体的评分吗?
心脏手术后心房颤动(POAF)与发病率和死亡率的增加有关。有几种评分方法可用于预测 POAF,但结果各不相同。因此,本研究评估了几种预测二尖瓣手术后 POAF 的评分系统的性能。此外,我们还确定了这些患者发生 POAF 的风险因素。这项回顾性队列包括 2009 年至 2021 年期间招募的 1381 名患者。这些患者接受了二尖瓣手术,其中233人(16.87%)发生了POAF。对 CHADS2、CHA2DS2-VASc、POAF、EuroSCORE II 和 HATCH 评分的性能进行了评估。发生 POAF 的患者的中位年龄更高(60 岁对 54 岁;P 58 岁,体重指数 > 28 kg/m2,肌酐清除率 2 显著预测 POAF(P < .001)。该评分的 AUCROC 为 0.67,明显高于 POAF 评分的 AUCROC(P = .009)。新的PSCC-AF评分能明显预测二尖瓣手术后的POAF,可作为POAF风险筛查的床旁诊断工具。PSCC-AF-二尖瓣评分需要进一步的外部研究来验证。
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