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Volume 32, Nº 6, November and December 2019

   

DOI: http://www.dx.doi.org/10.5935/2359-4802.20190042

ORIGINAL ARTICLE

Left Atrial Size Contribution to the Predictive Capacity of Two Scores for Atrial Fibrillation in the Postoperative Period of Cardiac Surgeries

Natália Aline da Silva

Rita de Cássia Gengo e Silva Butcher





Abstract

Background: Postoperative atrial fibrillation (POAF) is a common complication associated with undesirable outcomes; hence, the provision of appropriate tools is important to help identify patients at risk.

Objectives: To evaluate the predictive capacity of the CHADS2 and CHA2DS2-VASc scores, alone and combined with left atrial (LA) size, for the onset of POAF in patients undergoing coronary artery bypass grafting and/or valvular surgery.

Methods: We performed a retrospective cohort study on 144 patients. A decision tree was used to identify the cut-off values of the CHADS2 and CHA2DS2-VASc scores and LA size in order to calculate sensitivity, specificity, predictivevalue positive (PVP), and predictive-value negative (PVN), in addition to regression models. The receiver operating characteristic (ROC) curve was used to estimate the accuracy of the models. The level of significance adopted was 5%.

Results: Patients who developed POAF were older (p = 0.050), had reduced left ventricular ejection fraction (p = 0.045), longer hospital length of stay (p = 0,018), but their mean CHADS2 (p = 0.077) and CHA2DS2-VASc (p = 0.109) scores were similar to those of patients with no arrhythmia. LA size improved the predictive capacity of the CHADS2 score, in terms of specificity and PVP, and of the CHA2DS2-VASc score, in terms of sensitivity and PVN. However, the CHADS2 (OR = 1.198; CI95% = 0.859-1.156) and CHA2DS2-VASc (OR = 1.047; CI95% = 0.784- 1.401) scores were not predictors of POAF, either alone or in combination with LA size (OR = 1.163; CI95% = 0.829- 1.648 and OR = 1.065; CI95% = 0.795-1.433).

Conclusion: The CHADS2 and CHA2DS2-VASc scores alone or in combination with LA size did not show good predictive capacity for POAF. (Int J Cardiovasc Sci. 2019;32(6):585-593)

Keywords: Atrial Fibrillation; Arrhythmias, Cardiac/complications; Postoperative Complications; Cardiac Surgical Procedures.