Article

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: 1.11). 05/2008; 8(1):40-4. DOI: 10.1510/icvts.2007.173922
Source: PubMed

ABSTRACT 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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    • "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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