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Purpose: To evaluate whether pre-operative CHA2DS2-VASc score predicts the incidence of post-cardiothoracic surgery (CTS) atrial fibrillation (AF).
Methods: Patients (n=560) undergoing coronary artery bypass grafting and/or valvular surgery from the Atrial Fibrillation Suppression Trials I, II and III were evaluated in this nested cohort study. Data on patient demographics, surgical characteristics, medication utilization and the incidence of post-CTS AF (defined as AF lasting at least 5 min in duration documented by telemetry) were all uniformly and prospectively collected. All variables showing a univariate association (p ≤ 0.20) with AF occurrence were entered into a backwards, stepwise multivariate logistic regression to control for potential confounders and calculate adjusted odds ratios (AOR) with 95% confidence intervals (CI).
Results: The population was 67.8 ± 8.6 years old and 77.1% male. 34 (6.1%) patients had a CHA2DS2-VASc score of 0-1 (low), 261 (46.5%) patients had a score of 2-3 (medium), and 265 (47.3%) patients had a score of >3 (high). A total of 177 (31.6%) patients had post-CTS AF event, including 27%, 23%, and 41%, of the low, medium, and high CHA2DS2-VASc groups, respectively. Patients in the high-score group had a 2.3-fold increased odds of developing post-CTS AF as patients in the medium-score group (p<0.0001). The difference between the high and medium-score groups versus the low-score group was not statistically significant. On multivariate logistic regression higher pre-operative CHA2DS2-VASc score was associated with higher adjusted odds of developing post-CTS AF (AOR 1.27, 95% CI 1.05 to 1.53).
Conclusions: Increasing CHA2DS2-VASc score was a strong independent predictor for the development of post-CTS AF with patients in the high-score group having the highest overall incidence. Practitioners may be able to more accurately predict patients at highest risk for Post-CTS AF and ensure that optimal pharmacologic prophylaxis is initiated.