Importance of hatch score and relationship with CHA2DS2VASC score for predicting atrial fibrillation after coronary artery BYPASS surgery

Atrial fibrillation (AF) is the most common arrhytmia, with an incidence of 25-40%, after coronary artery bypass grafting (CABG). Previous reports have suggested that AF is associated with an increased incidense of mortality, stroke, heart failure, renal insufficiency, prolonged hospitalization and increased social costs. CHA2DS2VaSC score is the current scoring system which was composed to predict the risk of thromboembolism in AF patients. According to this system, requirement of anticoagulant treatment is determined and individual points are formed as the presence of congestive heart failure (C), hypertension (H), advanced age (A), diabetes mellitus (D), female sex (S), stroke (S) and vascular disease (V). In literature, limited number of studies are exist which was related to assess the risk of developing AF after CABG and to predicting hospitalization requirement about CHA2DS2VaSC score. As a result of these studies, AF after CABG was more frequent in patients with higher CHA2DS2VaSC score and also CHA2DS2VaSC score could be a predictor of hospitalization which was originated from cardiovascular diseases. HATCH scoring system was composed as calculating individual points based on the presence of hypertension (H), advanced age (A), transient ischemic attack or cerebrovascular event (T), chronic obstructive pulmonary disease (C) and congestive heart failure (H). In recent studies, higher HATCH score was found to be correlated with progression of AF. There have been no data in literature about HATCH score and prediction of AF after CABG. In this study, the situation of HATCH score to predicting AF after CABG and relationship with CHA2DS2VaSC score were investigated. Methods: In our study, patients who had CABG surgery as elective at the department of cardiovascular surgery in Adnan Menderes University Medical Faculty Hospital between 2011 and 2015 were researched retrospectively. 369 patients who had been providing inclusion criterias were admitted to the study. HATCH score and CHA2DS2VaSC score of the patients who had enrolled the study were estimated and patients were divided into groups according to these scorings. Furthermore, details of baseline clinical characteristics, preoperative treatment, echocardiographic features, angiographic findings, intraoperative and postoperative findings were recorded. Results: The incidence of AF was 28% (n=103, mean 2,6. days, mean 1,35 episodes, mean termination time 20,2 hours). The median age of patients with AF was significantly higher than the median age of sinus rhythm (SR) group (60,8 ± 10,0 years vs. 67,8± 9,5 years, p<0.001). In patients who developed postoperative AF, the median of HATCH score was detected as 1,5 (0-6); but in patients who maintained sinus rhythm at postoperative period, the median of HATCH score was detected as 1,2 (0-6). HATCH score was significantly higher in patients who developed postoperative AF than the sinus rhythm group (P=0.017). In patients who developed postoperative AF, the median of CHA2DS2VaSC score significantly higher than the sinus rhythm group (3,19 (0-7) versus 2,64 (0-6), p<0,002). Although, preoperative furosemide usage had been more frequent in the patients who developed AF after surgery than the SR group (6% versus 12%, P=0,047), these findings were not statistically significant in a multivariate analysis (p=0,252, p=0,370). Intensive care unit following time, total hospitalization time and complication rate were significantly higher in the AF group (Table 18). Conclusion: HATCH score might be a good predictor about AF after CABG. CHA2DS2VaSC score might be a good predictor about AF after CABG similarly as HATCH score.