• Diem T T Tran, Jeffery J Perry, Jean-Yves Dupuis, Elsayed Elmestekawy, and George A Wells.
• Division of Cardiac Anesthesiology, Department of Anesthesiology. Electronic address: dtran@ottawaheart.ca.
• J. Cardiothorac. Vasc. Anesth. 2015 Oct 1; 29 (5): 1117-26.

ObjectiveTo derive a simple clinical prediction rule identifying patients at high risk of developing new-onset postoperative atrial fibrillation (POAF) after cardiac surgery.DesignRetrospective analysis on prospectively collected observational data.SettingA university-affiliated cardiac hospital.ParticipantsAdult patients undergoing coronary artery bypass grafting and/or valve surgery.InterventionsObservation for the occurrence of new-onset postoperative atrial fibrillation.Measurements And Main ResultsDetails on 28 preoperative variables from 999 patients were collected and significant predictors (p<0.2) were inserted into multivariable logistic regression and reconfirmed with recursive partitioning. A total of 305 (30.5%) patients developed new-onset POAF. Eleven variables were associated significantly with atrial fibrillation. A multivariable logistic regression model included left atrial dilatation, mitral valve disease, and age. Coefficients from the model were converted into a simple 7-point predictive score. The risk of POAF per score is: 15.0%, if 0; 20%, if 1; 27%, if 2; 35%, if 3; 44%, if 4; 53%, if 5; 62%, if 6; and 70%, if 7. A score of 4 has a sensitivity of 44% and a specificity of 82% for POAF. A score of 6 has a sensitivity of 11% and a specificity of 97%. Bootstrapping with 5,000 samples confirmed the final model provided consistent predictions.ConclusionsThis study proposed a simple predictive score incorporating three risk variables to identify cardiac surgical patients at high risk of developing new-onset POAF. Preventive treatment should target patients ≥ 65 years with left atrial dilatation and mitral valve disease.Copyright © 2015 Elsevier Inc. All rights reserved.

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