scholarly journals Performance of EuroSCORE II and logistic EuroSCORE in Bangladeshi population undergoing off-pump coronary artery bypass surgery: A prospective cohort study

2019 ◽  
Vol 8 ◽  
pp. 204800401986212 ◽  
Author(s):  
Redoy Ranjan ◽  
Dipannita Adhikary ◽  
Sabita Mandal ◽  
Sanjoy Kumar Saha ◽  
Kamrul Hasan ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Brier Score ◽  
Artery Bypass Graft ◽  
Logistic Euroscore

Introduction European System for Cardiac Operative Risk Evaluation (EuroSCORE) was developed to identify patients who may have a greater postoperative risk for adverse effects following adult cardiac surgery. This study evaluated the discriminatory potential of using the EuroSCORE system in predicting the early, as well as late, postoperative outcomes following coronary artery bypass graft surgery in Bangladesh. Methods A total of 865 patients who underwent isolated coronary artery bypass graft surgery were evaluated with the EuroSCORE risk scoring system. Moreover, we also compared the discriminatory potentials between the EuroSCORE II and the original logistic EuroSCORE. Results Operative mortality was best predicted by EuroSCORE II (area under the curve (AUC) 0.863, Brier score 0.030) compared to the original logistic EuroSCORE (AUC 0.849, Brier score 0.033). However, the overall expected-to-observed mortality ratio for EuroSCORE II was 1.1, whereas the observed ratio for the original logistic EuroSCORE was 1.7. EuroSCORE II was predictive of an intensive care unit stay of five days or more (AUC 0.786), prolonged inotropes use (AUC 0.746), stroke (AUC 0.646), de novo dialysis (AUC 0.810), and low output syndrome (AUC 0.715). Moreover, a high EuroSCORE II quintile significantly predicted the risk for late mortality (p < 0.0001). Conclusions EuroSCORE has an important role in predicting the early, as well as late, postoperative outcomes following coronary artery bypass surgery. However, the performance of EuroSCORE II is significantly better than the original logistic EuroSCORE in predicting postoperative morbidity and mortality after isolated coronary artery bypass graft surgery among Bangladeshi patients.

scholarly journals Platelet Quiescence in Patients With Acute Coronary Syndrome Undergoing Coronary Artery Bypass Graft Surgery

2021 ◽  
Author(s):  
Kiran Sarathy ◽  
George A. Wells ◽  
Kuljit Singh ◽  
Etienne Couture ◽  
Aun Yeong Chong ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Coronary Syndrome

Background The optimal antiplatelet strategy for patients with acute coronary syndromes who require coronary artery bypass surgery remains unclear. While a more potent antiplatelet regimen will predispose to perioperative bleeding, it is hypothesized that through “platelet quiescence,” ischemic protection conferred by such therapy may provide a net clinical benefit. Methods and Results We compared patients undergoing coronary artery bypass surgery who were treated with a more potent antiplatelet inhibition strategy with those with a less potent inhibition through a meta‐analysis. The primary outcome was all‐cause mortality after bypass surgery. The analysis identified 4 studies in which the antiplatelet regimen was randomized and 6 studies that were nonrandomized. Combining all studies, there was an overall higher mortality with weaker strategies compared with more potent strategies (odds ratio, 1.38; 95% CI, 1.03–1.85; P =0.03). Conclusions Our findings support the concept of platelet quiescence, in reducing mortality for patients with acute coronary syndrome requiring coronary artery bypass surgery. This suggests the routine up‐front use of potent antiplatelet regimens in acute coronary syndrome, irrespective of likelihood of coronary artery bypass graft.

Obesity in Diabetic Patients Undergoing Coronary Artery Bypass Graft Surgery Is Associated with Increased Postoperative Morbidity

2006 ◽  
Vol 104 (3) ◽  
pp. 441-447 ◽  
Author(s):  
Wei Pan ◽  
Katja Hindler ◽  
Vei-Vei Lee ◽  
William K. Vaughn ◽  
Charles D. Collard
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Postoperative Outcomes ◽  
Diabetic Patients ◽  
Artery Bypass Graft ◽  
Increased Risk

Background Despite the fact that obesity is a known risk factor for cardiovascular disease, many studies have failed to demonstrate that obesity is independently associated with an increased risk of cardiovascular morbidity and mortality in nondiabetic patients undergoing coronary artery bypass graft surgery. The authors investigated the influence of obesity on adverse postoperative outcomes in diabetic and nondiabetic patients after primary coronary artery bypass surgery. Methods A retrospective cohort study of patients undergoing primary coronary artery bypass surgery (n = 9,862) between January 1995 and December 2004 at the Texas Heart Institute was performed. Diabetic (n = 3,374) and nondiabetic patients (n = 6,488) were classified into five groups, according to their body mass index: normal weight (n = 2,148), overweight (n = 4,257), mild obesity (n = 2,298), moderate obesity (n = 785), or morbid obesity (n = 338). Multivariate, stepwise logistic regression was performed controlling for patient demographics, medical history, and preoperative medications to determine whether obesity was independently associated with an increased risk of adverse postoperative outcomes. Results Obesity in nondiabetic patients was not independently associated with an increased risk of adverse postoperative outcomes. In contrast, obesity in diabetic patients was independently associated with a significantly increased risk of postoperative respiratory failure (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.41-3.61; P &lt; 0.001), ventricular tachycardia (OR, 2.27; 95% CI, 1.18-4.35; P &lt; 0.02), atrial fibrillation (OR, 1.56; 95% CI, 1.03-2.38; P &lt; 0.04), atrial flutter (OR, 2.38; 95% CI, 1.29-4.40; P &lt; 0.01), renal insufficiency (OR, 1.66; 95% CI, 1.10-3.41; P &lt; 0.03), and leg wound infection (OR, 5.34; 95% CI, 2.27-12.54; P &lt; 0.001). Obesity in diabetic patients was not independently associated with an increased risk of mortality, stroke, myocardial infarction, sepsis, or sternal wound infection. Conclusion Obesity in diabetic patients is an independent predictor of worsened postoperative outcomes after primary coronary artery bypass graft surgery.

scholarly journals Toward Dynamic Risk Prediction of Outcomes After Coronary Artery Bypass Graft: Improving Risk Prediction With Intraoperative Events Using Gradient Boosting

2021 ◽  
Author(s):  
Makoto Mori ◽  
Thomas J.S. Durant ◽  
Chenxi Huang ◽  
Bobak J. Mortazavi ◽  
Andreas Coppi ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Brier Score ◽  
Artery Bypass Graft ◽  
Precision Recall Curve ◽  
Recall Curve

Background: Intraoperative data may improve models predicting postoperative events. We evaluated the effect of incorporating intraoperative variables to the existing preoperative model on the predictive performance of the model for coronary artery bypass graft. Methods: We analyzed 378 572 isolated coronary artery bypass graft cases performed across 1083 centers, using the national Society of Thoracic Surgeons Adult Cardiac Surgery Database between 2014 and 2016. Outcomes were operative mortality, 5 postoperative complications, and composite representation of all events. We fitted models by logistic regression or extreme gradient boosting (XGBoost). For each modeling approach, we used preoperative only, intraoperative only, or pre+intraoperative variables. We developed 84 models with unique combinations of the 3 variable sets, 2 variable selection methods, 2 modeling approaches, and 7 outcomes. Each model was tested in 20 iterations of 70:30 stratified random splitting into development/testing samples. Model performances were evaluated on the testing dataset using the C statistic, area under the precision-recall curve, and calibration metrics, including the Brier score. Results: The mean patient age was 65.3 years, and 24.7% were women. Operative mortality, excluding intraoperative death, occurred in 1.9%. In all outcomes, models that considered pre+intraoperative variables demonstrated significantly improved Brier score and area under the precision-recall curve compared with models considering pre or intraoperative variables alone. XGBoost without external variable selection had the best C statistics, Brier score, and area under the precision-recall curve values in 4 of the 7 outcomes (mortality, renal failure, prolonged ventilation, and composite) compared with logistic regression models with or without variable selection. Based on the calibration plots, risk restratification for mortality showed that the logistic regression model underestimated the risk in 11 114 patients (9.8%) and overestimated in 12 005 patients (10.6%). In contrast, the XGBoost model underestimated the risk in 7218 patients (6.4%) and overestimated in 0 patients (0%). Conclusions: In isolated coronary artery bypass graft, adding intraoperative variables to preoperative variables resulted in improved predictions of all 7 outcomes. Risk models based on XGBoost may provide a better prediction of adverse events to guide clinical care.

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