Advertisement

Predicting Atrial Fibrillation After CABG

Postoperative atrial fibrillation (AF) occurs in 15% to 30% of patients who undergo isolated CABG. Patients who develop AF after these procedures are at risk for longer hospital stay, perioperative morbidity and mortality, and long-term mortality. Identifying specific patients who are at high risk for developing AF after CABG may help define a population that is more likely to benefit from antiarrhythmic drugs or other AF prevention strategies. Evaluating a Simple AF Risk Model Previous analyses of patients undergoing CABG have suggested that certain preoperative, intraoperative, and postoperative factors can be used to determine the risk of postoperative AF (POAF), but these models can be cumbersome to apply and may not always be useful. In the American Journal of Cardiology, my colleagues and I had a study published that tested a simplified clinical tool using preoperative patient characteristics to identify those at high risk for POAF following CABG. Using the Society of Thoracic Surgery database, we identified a subset of preoperative variables that predispose patients to POAF. Using these variables, we created a risk index that had a moderate prediction power to identify patients at high risk of developing POAF. Patients were assigned point values according to the AF Risk Index Table. Patients scoring 4 points on the AF risk index had a 30% to 40% chance of developing POAF. Conversely, those with a score of 0 points had a less than 10% risk. “Identifying specific patients who are at high risk for developing AF after CABG may help define a population that is more likely to benefit from anti-arrhythmic drugs or other AF prevention strategies.” Mikhael F. El-Chami, MD...

Revascularizing Occluded Arteries: Assessing the Influence of Guidelines

The Occluded Artery Trial (OAT) was a large, randomized controlled study funded by the National Heart, Lung, and Blood Institute that tested routine percutaneous recanalization of persistently totally occluded infarct-related arteries identified a minimum of 24 hours after myocardial infarction (MI) in stable patients who did not have triple vessel disease or severe inducible ischemia. In 2006, results from OAT were released, showing that there appears to be no benefit to routinely using PCI for persistently totally occluded infarct-related arteries in this patient population. Routine PCI for these arteries did not reduce mortality, reinfarction, or class IV heart failure. These results subsequently led to updates of guidelines from the American College of Cardiology (ACC) and American Heart Association (AHA) on unstable angina/non-STEMI, STEMI, and PCI in 2007. The revised guidelines recommended that PCI not be performed in this context. Prior to OAT data being released, clinicians tended to favor using PCI for persistent infarct-related artery occlusions largely because of experimental and observational data. “OAT results demonstrated that use of PCI did not lead to a reduction in clinical events,” explains Judith S. Hochman, MD. “The beneficial effect on angina and quality of life was small and not durable. OAT also suggested that PCI was more costly than optimal medical therapy alone. As a result, these findings should have discouraged routine PCI in this setting.” Assessing the Impact of the OAT Study In the October 10, 2011 Archives of Internal Medicine, Dr. Hochman and colleagues had a study published in which they examined whether PCI use for treating occluded infarct-related arteries after an MI decreased following the publication of OAT...
[ HIDE/SHOW ]