Changing risk of patients undergoing coronary artery bypass surgery

Department of Surgery, Division of Cardio-thoracic and Vascular Surgery, Oulu University Hospital, Oulu, Finland.
Interactive Cardiovascular and Thoracic Surgery (Impact Factor: 1.16). 05/2008; 8(1):40-4. DOI: 10.1510/icvts.2007.173922
Source: PubMed


The aim of the present study was to evaluate the changing risk of patients undergoing coronary artery bypass grafting (CABG). Residents of Oulu who underwent coronary angiography and/or revascularization from 1993 to 2006 formed the basis of this community-wide study. One thousand three hundred and forty-nine consecutive patients who underwent CABG have been included in the analysis on changing operative risk and results after CABG. A significant increase in the operative risk occurred in patients who underwent CABG (mean logistic EuroSCORE in 1278 patients: 1993-1997: 3.7%; 1998-2002: 4.6%; 2003-2006: 5.4%; P<0.0001). Thirty-day mortality decreased during the last period (1993-1997: 2.5%; 1998-2002: 3.0%; 2003-2006: 1.6%; P=0.49). The area under the ROC curve of logistic EuroSCORE (1993-1997: 0.86; 1998-2002: 0.78; 2003-2006: 0.99) for prediction of 30-day postoperative mortality markedly improved during the last study period. Despite the increased operative risk, off-pump coronary surgery was associated with lower immediate postoperative mortality rates. Contrary to on-pump surgery, immediate postoperative death occurred after off-pump surgery only in patients with additive EuroSCORE >or=6. The results of this study suggest that improved perioperative care as well as changes in operative strategy are positively faced with the increased burden of comorbidities and operative risk of patients currently undergoing CABG.

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Available from: Fausto Biancari, Jun 15, 2014
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    • "patient population in Germany. This was also true for the EuroSCORE with other populations [1] [2] [3]. Thus, the comprehensive national data pool in Germany was used to calculate predicted mortalities based on evaluated risk factors. "
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    ABSTRACT: Objectives: The aim of the study was to establish a scoring system to predict mortality in aortic valve procedures in adults [German Aortic Valve Score (German AV Score)] based upon the comprehensive data pool mandatory by law in Germany. Methods: In 2008, 11 794 cases were documented who had either open aortic valve surgery or transcatheter aortic valve implantation (TAVI). In-hospital mortality was chosen as a binary outcome measure. Potential risk factors were identified on the basis of published scoring systems and clinical knowledge. First, each of these risk factors was tested in an univariate manner by Fisher's exact test for significant influence on mortality. Then, a multiple logistic regression model with backward and forward selection was used. Calibration was ascertained by the Hosmer-Lemeshow method. In order to define the quality of discrimination, the area under the receiver operating characteristic (ROC) curve was calculated. Results: In 11 147 of 11 794 cases (94.5%), a complete data set was available. In-hospital mortality was 3.7% for all patients, 3.4% in the surgical group (95% confidence interval 3.0-3.7%, n = 10 574) and 10.6% in the TAVI group (95% confidence interval 8.2-13.5%, n = 573). Based on multiple logistic regression, 15 risk factors with an influence on mortality were identified. Among them, age, body mass index and left ventricular function were categorized in three (body mass index, left ventricular dysfunction) or 6 subgroups (age). The Hosmer-Lemeshow method corroborated a valid concordance of predicted and observed mortality in 10 different risk groups. The area under the ROC curve with a value of 0.808 affirmed the quality of discrimination of the established scoring model. Conclusions: It is well known that a predictive model works best in the setting where it was developed; therefore, the German AV Score fits well to the patient population in Germany. It was designed for fair and reliable outcome evaluation. It allows comparison of predicted and observed mortality for conventional aortic valve surgery and transcatheter aortic valve implantation in low-, moderate- and high-risk groups. Thus, it enables primarily a risk-adjusted benchmark of outcome and fosters the efforts for continuous improvement of quality in aortic valve procedures.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 03/2013; 43(5). DOI:10.1093/ejcts/ezt114 · 3.30 Impact Factor
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    • "About 20,000 first time CABG operations are performed in the United Kingdom each year with an average mortality of 1.6% according to the latest healthcare commission report in the United Kingdom. However, the risk profile of patients being referred for cardiac surgery continues to change with factors such as the aging population, the increasing incidence of diabetes and more complex percutaneous coronary interventions, resulting in higher-risk patients being operated upon [1]. These patients are at a greater risk of sustaining peri-procedural myocardial injury, experiencing a perioperative myocardial infarction, and requiring inotropic support post-surgery [2]. "
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    ABSTRACT: Coronary heart disease (CHD) is the leading cause of death worldwide. Coronary artery bypass graft (CABG) surgery remains the procedure of choice for coronary artery revascularisation in a large number of patients with severe CHD. However, the profile of patients undergoing CABG surgery is changing with increasingly higher-risk patients being operated upon, resulting in significant morbidity and mortality in this patient group. Myocardial injury sustained during cardiac surgery, most of which can be attributed to acute myocardial ischaemia–reperfusion injury, is associated with worse short-term and long-term clinical outcomes. Clearly, new treatment strategies are required to protect the heart during cardiac surgery in terms of reducing myocardial injury and preserving left ventricular systolic function, such that clinical outcomes can be improved. ‘Conditioning’ the heart to harness its endogenous cardioprotective capabilities using either brief ischaemia or pharmacological agents, provides a potentially novel approach to myocardial protection during cardiac surgery, and is the subject of this review article.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 06/2009; 35(6-35):977-987. DOI:10.1016/j.ejcts.2009.02.014 · 3.30 Impact Factor
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    ABSTRACT: Introduction and objectives: Preoperative anemia as a risk factor of adverse outcomes after coronary surgery has not been well-established. This study has aimed to analyze the association between preoperative anemia and postoperative adverse events and inhospital mortality in the patients undergoing isolated coronary artery bypass graft surgery in the Son Dureta hospital. Methods: All the patients undergoing isolated coronary artery bypass graft surgery with extracorporeal circulation from November 2002 to June 2007 were included. Preoperative anemia was defined as hemoglobin (Hb)<13g/dL in men and Hb<12g/dL in women. The association between postoperative cardiac and noncardiac adverse events and the presence or absence of preoperative anemia and concomitant surgical risk, assessed by logistic EuroScore, were analyzed. Results: A total of 623 patients were included. The rate of preoperative anemia was 34.5%. Patients with Euroscore >4 had higher incidence of preoperative anemia than patients with Euroscore<4 (41% vs. 27%; p=0.0001). There were no statistically significant differences in the rate of postoperative adverse events related to the presence or absence of preoperative anemia. Median ICU and hospital length of stay were longer in patients with preoperative anemia than in patients without preoperative anemia (ICU: 3.2±2.5 days vs. 3.7±2.8, p=0.004; inhospital: 17.5±11.3 days vs. 14.7±10.2, p=0.001). Hospital mortality rate was 0.8% (95% CI 0.3-1.9). There were no differences in the mortality rate of the patients with and without preoperative anemia (0.9% vs 0.7%, p=0.8). Conclusions: In this study, preoperative anemia in patients undergoing coronary artery bypass graft surgery was not associated with increased hospital morbidity-mortality. However, ICU and hospital length of stay were longer in patients with preoperative anemia. The limitation of the sample size prevents us from confirming whether preoperative anemia is a risk factor after coronary surgery or not.
    Medicina Intensiva 11/2009; 33(8):370-376. DOI:10.1016/j.medin.2009.04.008 · 1.34 Impact Factor
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