Abstract 15918: A Combined Clinical and Genetic Risk Model for Predicting Postoperative Atrial Fibrillation
Introduction: Postoperative atrial fibrillation (PoAF) is a common adverse event following CABG. We evaluated whether single nucleotide polymorphisms (SNPs) linked to AF susceptibility in a recent meta-analysis of genome-wide association studies improve the clinical risk prediction model for PoAF.
Methods: The Discovery cohort included 645 patients in the Vanderbilt Cardiac Surgery Registry undergoing CABG without concurrent valve surgery. The Validation cohort consisted of 644 patients in the CABG Genomics Program at Brigham and Women’s Hospital and the Texas Heart Institute. PoAF up to 7 days following surgery was determined. Clinical variables included age, race, sex, previous AF, diabetes, HTN, heart failure, MI, LVEF, PR interval, and use of beta-blockers, ACE inhibitors, statins, aspirin, and COX inhibitors. Thirteen SNPs were included: rs13376333 and rs6666258 at 1q21; rs3903239 at 1q24; rs2200733, rs10033464 and rs6817105 at 4q25; rs3807989 at 7q31; rs10821415 at 9q22; rs10824026 at 10q22; rs1152591 at 14q23; rs7164883 at 15q24; rs2106261 and rs7193343 at 16q22.
Results: The incidence of PoAF was 15% in the Discovery and Validation cohorts. A multiple logistic regression model for predicting PoAF containing 11 SNPs and all clinical covariates was highly significant (P<0.001). In the Discovery cohort, the combined genetic/clinical model was superior to the clinical-only model [areas under the receiver operator characteristic (ROC) curves 0.816 and 0.759, respectively, P<0.001 (Figure)]. When applied to the Validation cohort, the areas under the ROC curves were 0.701 and 0.651 for the combined and clinical-only models, respectively (P<0.001).
Conclusion: We found that a combined clinical and genetic risk model was not only predictive for the development of PoAF but was superior to a model using only clinical risk factors. Pre-procedural genotyping of AF susceptibility alleles may improve risk stratification in patients undergoing CABG.
- © 2013 by American Heart Association, Inc.