CHA2DS2-VASc Score for Identifying Patients at high risk of Postoperative Atrial Fibrillation after Cardiac Surgery: A Meta-analysis

Abstract Background Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery, resulting in an increased risk of morbidity and longer hospital stay. Pharmacologic prophylaxis has been recommended to improve outcome in patients at high risk of developing POAF after cardiac surgery. Several studies have applied CHA2DS2-VASc score in the risk stratification of POAF but yielded contradicting results. This study aims to determine the association between CHA2DS2-VASc score and POAF, and further to explore its discriminative ability for the prediction of POAF. Methods We systematically searched the Medline, Embase, Cochrane library and other data sources with key terms “CHA2DS2-VASc”, “atrial fibrillation” and “cardiac surgery”. Studies were designed for CHA2DS2-VASc score in stratifying the risks for POAF in patients undergoing cardiac surgery were included. Statistical analyses were performed using R 3.5.1 and STATA 13.0. Results 721 studies were identified, out of which 12 studies with 18,086 patients were finally included in our analysis. The CHA2DS2-VASc score was found to be an independent predictor of POAF following cardiac surgery (OR 1.46, 95% CI 1.25 to 1.72), and exhibited a relatively strong specificity (0.70, 95% CI 0.61 to 0.78) and sensitivity (0.72, 95% CI 0.54 to 0.85) for predicting POAF. The bivariate model-based pooled area under the ROC was estimated to be 0.76 (95% CI 0.72 to 0.79). Conclusions The CHA2DS2-VASc score has relatively good performance in predicting POAF after cardiac surgery and may help identify the patients at high risk of POAF.