Predictive Nomogram Model For Atrial Fibrillation After Coronary Artery Bypass Grafting

OBJECTIVE:The related influencing factors of new atrial fibrillation after off-pump coronary artery bypass grafting were analyzed retrospectively.Select valuable predictors to design the nomogram for risk prediction of new atrial fibrillation after off-pump coronary artery bypass grafting.METHODS:78 patients undergoing off-pump coronary artery bypass grafting(OPCAB)in our hospital from September 2017 to September 2019 were selected as research objects.The selected subjects were divided into two groups according to whether there was postoperative new-onset atrial fibrillation(POAF)between postoperative return to intensive care unit and discharge from hospital.The new-onset atrial fibrillation group and the non-atrial fibrillation group.Single factor and multi-factor analysis were used to explore the influencing factors of new postoperative atrial fibrillation.To screen the influencing factors of new postoperative atrial fibrillation and establish nomogram.Bootstrap method was used for verification.Calculate the discrimination degree of consistency index evaluation model.The area under ROC curve(AUC)was used to evaluate the prediction efficiency of the model.RESULTS:1 In this study,there were 72 OPCAB patients complicated with POAF in 26 cases,with an incidence of 33.3%.2 Age(OR=0.769,95%CI(0.599～0.998)),body mass index(OR=0.798,95%CI(0.651～0.997)),left atrial diameter(OR=1.701,95%CI(1.383-2.091)),ejection fraction(OR=1.433,95%CI(1.139～ 1.804)),preoperative neutrophil to lymphocyte ratio(OR=1.091,95%CI(1.042～1.142),the ratio of preoperative platelets to lymphocytes(OR=0.999,95%CI(0.998 ～ 0.999)),and postoperative lactic acid(OR=1.068,95%CI(1.015～1.124))were independent influencing factors for the occurrence of POAF(P < 0.05).3 Gender,smoking history,diabetes history,hyperlipidemia history,hypertension history,preoperative myocardial infarction history,left ventricular end diastolic diameter,coronary artery lesion number,preoperative white blood cell number,preoperative total cholesterol,preoperative triglyceride,preoperative high density lipoprotein cholesterol,preoperative low density lipoprotein cholesterol,preoperative blood sugar,preoperative lactic acid,preoperative potassium,surgical duration,graft blood vessel number,postoperative blood sugar,postoperative potassium,postoperative white blood cell number,The ratio of neutrophil to lymphocyte,platelet to lymphocyte,total cholesterol,triglyceride,high density lipoprotein cholesterol and low density lipoprotein cholesterol had no significant difference between the two groups(P>0.05)4 The consistency index of POAF predicted by the histogram model was 0.912;The ROC curve analysis of the predicted probability line of the nomogram model shows that the AUC is 0.92.Conclusion:1 Multivariate analysis showed that age,BMI,LAD,LVEF,preoperative NLR,preoperative PLR and postoperative lactic acid were independent influencing factors of new atrial fibrillation after coronary artery bypass grafting.2 The 7 potential predictors discovered in this study,including age,BMI,LAD,LVEF,preoperative NLR,preoperative PLR,and postoperative lactic acid,are all routine clinical items and are easy to obtain.3 The nomogram model for predicting POAF risk of OPCAB patients is designed for the first time,which can individually predict POAF risk,contribute to the early prevention of POAF,is easy for clinical promotion and has strong practicability.