What Influences the Patients with Left Atrial Myxoma: From Embolism to Postoperative Atrial Fibrillation

Development and internal validation of an OPCABG-specific prediction model for postoperative atrial fibrillation in Chinese patients: a retrospective cohort study

BACKGROUND

Postoperative atrial fibrillation (POAF) is a common complication after off-pump coronary artery bypass grafting (OPCABG), associated with increased morbidity and healthcare costs. Existing POAF prediction models, developed mainly for Western populations, may not account for genetic, lifestyle, and healthcare disparities in Chinese patients. This study aimed to develop and validate a Chinese-specific nomogram for POAF risk stratification in OPCABG patients.

METHODS

A retrospective cohort study was conducted at a single Chinese center, including 456 consecutive OPCABG patients (2018-2022). Patients were divided into a training set (2018-2021, n = 319) and validation set (2022, n = 137). Multivariable logistic regression with LASSO regularization identified predictors of POAF (occurrence within 7 postoperative days). Model performance was evaluated using C-index, calibration curves, decision curve analysis (DCA), and clinical impact curves (CIC).

RESULTS

The final nomogram included five independent predictors: age (OR, 1.03), diabetes (OR, 1.85), hypertension (OR, 1.90), previous PCI (OR, 2.51) and last intraoperative blood potassium concentration (OR, 0.30). The model demonstrated excellent discrimination (C-index: 0.809 in training, 0.886 in validation) and good calibration. DCA and CIC showed superior clinical utility compared with existing scores (C2HEST, CHADS2, CHA2DS2-VASc).

CONCLUSIONS

This OPCABG-specific nomogram outperforms conventional risk scores in predicting POAF in Chinese patients, enabling personalized prophylaxis and resource allocation. External validation in diverse populations is needed to confirm generalizability.

Predictors of Late Mortality in Patients With Surgically Resected Cardiac Myxomas: A Single-Center Experience

Background and objective

Myxomas are the most common cardiac tumors. This study aimed to analyze the possible risk factors associated with late mortality in this group of patients and assess long-term survival.

Methods

A retrospective study was conducted among patients who underwent myxomas resection between January 2008 and July 2019 in our service. The patients' preoperative, intraoperative, and postoperative data were analyzed. Multivariate logistic regression was performed to identify predictors of mortality at five years. The Kaplan-Meier curve and Cox proportion-adjusted survival curves were used to assess mortality at five and 10 years.

Results

A total of 108 patients with cardiac myxomas were identified. All cardiac tumors resected were confirmed as myxomas on histopathological examination. Ninety-six patients presented with left-side myxomas (94 left-atria and two left-ventricle) and 12 with right-side myxomas (11 right-atria, one right-ventricle); 78 of the tumors were capsulated, and 30 were sessile-papillary. The mean dimensions were 37 ±6.1 mm on the left side and 41 ±6.7 mm on the right side. Surgical excision was successful in all cases, with 25% requiring interatrial septum patch repair. Recurrence occurred in 2.77% of the patients. Multivariate logistic regression showed chronic kidney disease (CKD) (OR: 7.96, 95% CI: 1.469-43.125, p=0,016) to be an independent predictor for five-year mortality. The mean follow-up period was 7.13 ±2.965 years, and the Kaplan-Meier curve cumulative proportion survival of patients at five years and 10 years were 100% and 88.8%, respectively. There was no statistically significant difference in late-term survival between patients with and without CKD in the Cox proportion-adjusted survival curve (p=0.275).

Conclusions

Patients with myxomas have a good long-term prognosis following surgical resection. The multivariate logistic regression showed CKD to be an independent predictor of five-year mortality.