Abstract 10652: A Novel Perioperative Cardiac Stress Score for Predicting Atrial Fibrillation and Mortality After Coronary Artery Bypass Grafting

H. Abu Khadija A. Kogan Nizar Abu Hamdeh K. Ibraheem Alaa Zayed Eyal Nachum Duha Najajra M. Masu'd H. Abdul-Hafez Y. Fraitekh E. Raanani Ahmed O. Sena Ehsan Shaban Muath A. Baniowda Ahmed M. Azzam Qutaiba Qafisheh E. Hellou Hanaa Rashid Izzeddin Swidan Mariam Assi O. Alhaj L. Sternik Odai Alkhdour Ma'in Abumuhfouz Salem K. Qupp Nasim Abukaresh Mohammad A. Altakroury Michael Matarweh Nadine Khamaisi O. Ayyad A. Hassan Lawi Suissa Ehud Karni M. Abdo M. Alnees

Nov 2026 · Circulation · 0 citations

Abstract

Background: Postoperative atrial fibrillation (POAF) remains a common complication after coronary artery bypass grafting (CABG) and is associated with increased morbidity and mortality. Existing risk stratification tools rely primarily on preoperative variables and may not adequately capture perioperative physiological stress. Objectives: To evaluate the association of a novel perioperative Cardiac Stress Score (CSS) with 30-day POAF and long-term all-cause mortality, and to assess its incremental predictive value beyond postoperative troponin. Methods: This retrospective multicenter cohort study included 6,137 patients undergoing isolated CABG across four centers in Israel and the West Bank. The CSS is a simple integer-based score (range 0-6) derived from postoperative troponin, aortic cross-clamp time, and serum creatinine. Associations with outcomes were evaluated using Cox proportional hazards models with stepwise adjustment. Discriminative performance was assessed using receiver operating characteristic (ROC) analysis, and Kaplan-Meier curves were used for time-to-event analyses. Results: POAF occurred in 20.3% of patients. Each 1-point increase in CSS was independently associated with a higher risk of POAF (adjusted HR 1.37, 95% CI 1.33-1.42; p < 0.001) and long-term mortality (adjusted HR 1.54, 95% CI 1.47-1.62; p < 0.001). A clear graded relationship was observed, with POAF incidence increasing from approximately 10% at a score of 0 to over 50% in higher score categories. The CSS demonstrated superior discrimination for POAF compared with postoperative troponin alone (AUC 0.70 vs. 0.67; p = 0.0008). Kaplan-Meier analysis showed stepwise increases in POAF incidence and reduced long-term survival across CSS tertiles (log-rank p < 0.001). Conclusion: The Cardiac Stress Score is a simple and clinically applicable tool that integrates perioperative myocardial injury, ischemic burden, and renal dysfunction. It independently predicts POAF and long-term mortality after CABG and provides incremental prognostic value beyond postoperative troponin. Further external validation is warranted.

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