CoChat
Sign Up
Cited by 1,234Atrial Fibrillation Management and OutcomesCardiac and Coronary Surgery TechniquesCardiac, Anesthesia and Surgical Outcomes

The DOI matches its Crossref record; 35 of the 35 references it cites were found in a registry or an index.

A Multicenter Risk Index for Atrial Fibrillation After Cardiac Surgery

Mathew, Joseph P.·2004·JAMA
DOI 10.1001/jama.291.14.1720
Open this paper in CoChat — free account

Abstract

CONTEXT: Atrial fibrillation is a common, but potentially preventable, complication following coronary artery bypass graft (CABG) surgery. OBJECTIVES: To assess the nature and consequences of atrial fibrillation after CABG surgery and to develop a comprehensive risk index that can better identify patients at risk for atrial fibrillation. DESIGN, SETTING, AND PARTICIPANTS: Prospective observational study of 4657 patients undergoing CABG surgery between November 1996 and June 2000 at 70 centers located within 17 countries, selected using a systematic sampling technique. From a derivation cohort of 3093 patients, associations between predictor variables and postoperative atrial fibrillation were identified to develop a risk model, which was assessed in a validation cohort of 1564 patients. MAIN OUTCOME MEASURE: New-onset atrial fibrillation after CABG surgery. RESULTS: A total of 1503 patients (32.3%) developed atrial fibrillation after CABG surgery. Postoperative atrial fibrillation was associated with subsequent greater resource use as well as with cognitive changes, renal dysfunction, and infection. Among patients in the derivation cohort, risk factors associated with atrial fibrillation were advanced age (odds ratio [OR] for 10-year increase, 1.75; 95% confidence interval [CI], 1.59-1.93); history of atrial fibrillation (OR, 2.11; 95% CI, 1.57-2.85) or chronic obstructive pulmonary disease (OR, 1.43; 95% CI, 1.09-1.87); valve surgery (OR, 1.74; 95% CI, 1.31-2.32); and postoperative withdrawal of a beta-blocker (OR, 1.91; 95% CI, 1.52-2.40) or an angiotensin-converting enzyme (ACE) inhibitor (OR 1.69; 95% CI, 1.38-2.08). Conversely, reduced risk was associated with postoperative administration of beta-blockers (OR, 0.32; 95% CI, 0.22-0.46), ACE inhibitors (OR, 0.62; 95% CI, 0.48-0.79), potassium supplementation (OR, 0.53; 95% CI, 0.42-0.68), and nonsteroidal anti-inflammatory drugs (OR, 0.49; 95% CI, 0.40-0.60). The resulting multivariable risk index had adequate discriminative power with an area under the receiver operating characteristic (ROC) curve of 0.77 in the validation sample. Forty-three percent (640/1503) of patients who had atrial fibrillation after CABG surgery experienced more than 1 episode of atrial fibrillation. Predictors of recurrent atrial fibrillation included older age, history of congestive heart failure, left ventricular hypertrophy, aortic atherosclerosis, bicaval venous cannulation, withdrawal of ACE inhibitor or beta-blocker therapy, and use of amiodarone or digoxin (area under the ROC curve of 0.66). Patients with recurrent atrial fibrillation had longer hospital stays and experienced greater infectious, renal, and neurological complications than those with a single episode. CONCLUSIONS: We have developed and validated models predicting the occurrence of atrial fibrillation after CABG surgery based on an analysis of a large multicenter international cohort. Our findings suggest that treatment with beta-blockers, ACE inhibitors, and/or nonsteroidal anti-inflammatory drugs may offer protection. Atrial fibrillation after CABG surgery is associated with important complications.

Overview

Integrity signals

Registry

Crossref · 10.1001/jama.291.14.1720

Cites

35 of 35 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Verification

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Citations

Cites

Show all 35 references

Cited by

Sorted by citations

Items 301–400 of 999

Related

See all

Metadata

Authors
Mathew, J. P.
Affiliations
Duke University (US)
Corresponding author
Mathew, Joseph P.
ORCID
Mathew, Joseph P.
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2004-04-14
Volume
291
Issue
14
Pages
1720
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.291.14.1720
OpenAlex
W2078856783
Cited by
1,234
References
35
Citations by year
2026: 40 · 2025: 48 · 2024: 44 · 2023: 52 · 2022: 60 · 2021: 70 · 2020: 51 · 2019: 50 · 2018: 56 · 2017: 58 · 2016: 61 · 2015: 52 · 2014: 82 · 2013: 49 · 2012: 66
FWCI
28.97
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • University of Ottawa
  • University of Alberta
  • University of Toronto
  • Karl-Franzens-Universität Graz
  • Institut de Cardiologie de Montréal
  • Faculty of Medicine Siriraj Hospital, Mahidol University
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
  • Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
Keywords
postoperative atrial fibrillation, coronary artery bypass grafting, risk index, risk factors, beta-blockers, ACE inhibitors, potassium supplementation, postoperative complications, resource utilization (health care), cognitive change, renal dysfunction, infection, old age, chronic obstructive pulmonary disease, valve surgery, risk prediction model, quality of life, mortality, length of hospital stay, cost of care
MeSH terms
Aged, Coronary Artery Bypass, Atrial Fibrillation, Female, Humans, Male, Middle Aged, Postoperative Complications, Prospective Studies, Models, Statistical, Risk Assessment

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review