The Influencing Factors On Atrial Fibrillation After Off-pump Coronary Artery Bypass Grafting And Establishment Of Classification Prediction Models

BackgroundPost-operative atrial fibrillation（POAF）is a common complication after coronary artery bypass transplantation,which significantly increases the risk of stroke and death.Although POAF has been extensively studied,However,the pathophysiological mechanism of atrial fibrillation after cardiac surgery is not completely clear,and the incidence of atrial fibrillation has not been significantly reduced,and the influencing factors of atrial fibrillation after coronary artery bypass transplantation remain to be further clarified.ObjectiveTo investigate the influencing factors of postoperative atrial fibrillation（POAF）after off-pump coronary artery bypass grafting（OPCABG）,construction of classifier models,and analyze the results of cardiac color doppler ultrasound after 12 months of follow-up.MethodsThis study was a retrospective study,a total of 202 patients who received OPCABG in the Zhengzhou No.7 People’s Hospital from April 2016 to April 2018,they were randomly divided into training set（n=151）and test set（n=51）according to the ratio of 3:1,and divided into POAF group and non-POAF group according to whether POAF occurred.The perioperative clinical data of the patients were collected.Multivariate Logistic regression model was used to analyze the influencing factors of POAF after OPCABG,and two classifier models were constructed based on Logistic regression（LR）and K-nearest neighbor algorithm（KNN）.The results of cardiac color doppler ultrasound and the incidence of major cardiovascular events（MACCE）were followed up 12 months after OPCABG.Results1.Multivariate Logistic regression analysis showed that age,hypertension,acute myocardial infarction（AMI）,right coronary artery（RCA）stenosis,frequent atrial premature contraction or atrial tachycardia,renal insufficiency and preoperative useβ-receptor blockers,preoperative left anterior and posterior atrial diameter（LAAP）and postoperative left ventricular ejection fraction（LVEF）were the influencing factors of POAF after OPCABG（P<0.05）.2.The regression equation was:ln[P_POAF/(1-P_POAF)]=0.107×age+0.092×hypertension+0.052×AMI+0.057×RCA stenosis+0.104×frequent atrial premature contraction or atrial tachycardia+0.084×renal insufficiency-0.097×preoperative useβ-receptor blockers+0.053×preoperative LAAP-0.056×postoperative LVEF-0.318.The confusion matrix is constructed according to the regression equation of the test set data,and its accuracy is 0.922 and 0.882.3.3,6 and 12 months after operation LVEF were higher than those before operation,and LVESD,LVEDD and LAAP were lower than those before operation in the non-POAF group and POAF group（P<0.05）.4.At 12 months after operation,recurrence of atrial fibrillation in 8 cases in POAF group,and the recurrence rate was 22.2%.The incidence of MACCE in POAF group was higher than that in non-POAF group（χ~2=5.043,P=0.025）.Conclusions1.Age,hypertension,AMI,RCA stenosis,frequent atrial premature contraction or atrial tachycardia,renal insufficiency and preoperative useβ-receptor blockers,preoperative LAAP and postoperative LVEF are the influencing factors of POAF after OPCABG.2.The prediction efficiency of the two classifier models are good.The cardiac structure and function are improved during follow-up,but the incidence of MACCE is higher in patients with POAF.