Risk stratification analysis of operative mortality in isolated coronary artery bypass graft patients in Pakistan: comparison between additive and logistic EuroSCORE models

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.

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Cardiac and Neurologic Complications Identify Risks for Mortality for Both Men and Women Undergoing Coronary Artery Bypass Graft Surgery

Anesthesiology ◽

10.1097/00000542-200111000-00008 ◽

2001 ◽

Vol 95 (5) ◽

pp. 1074-1078 ◽

Cited By ~ 32

Author(s):

Charles W. Hogue ◽

Thoralf Sundt ◽

Benico Barzilai ◽

Kenneth B. Schecthman ◽

Victor G. Dávila-Román

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Operative Mortality ◽

Artery Bypass ◽

Bypass Graft ◽

Artery Bypass Graft ◽

Low Cardiac Output Syndrome ◽

Low Cardiac Output

Background Despite a number of studies showing that women and men respond to coronary artery bypass graft surgery differently, it is not known whether variables associated with mortality are the same for women and men. The purpose of this study was to identify variables independently associated with mortality for women undergoing coronary artery bypass graft surgery. Methods Single-institutional data were prospectively collected from 5,113 patients (1,558 or 30.5% women) undergoing coronary artery bypass graft surgery. The database was reviewed for patient characteristics and operative outcomes based on sex. Complications evaluated included low cardiac output syndrome (cardiac index < 2.0 l x min(-1) x m(-2) for > 8 h, regardless of treatment), stroke (new permanent global or focal motor deficits), Q-wave myocardial infarction, postoperative atrial fibrillation, and operative mortality. Results Women were older than men, and they were more likely to have preexisting hypertension, diabetes, and a history of stroke. Operative mortality for women was higher than for men (3.5% vs. 2.5%, P < 0.05). Compared with men, women were more likely to experience a postoperative myocardial infarction, stroke, and low cardiac output syndrome. When performing analysis on data from both sexes separately, low cardiac output syndrome, new stroke, myocardial infarction, and duration of cardiopulmonary bypass were independently associated with mortality for women and men both. Patient age was not independently associated with risk for mortality for women, but it was for men. However, when the authors combined both sexes in the logistic regression analysis, the age-sex interaction was not significant (P = 0.266), indicating that there was insufficient evidence to assert that age has a different effect on mortality for men and women. Conclusions These data confirm that women have higher perioperative mortality after coronary artery bypass graft surgery compared with men. A higher frequency of cardiac and neurologic complications seem to account to a large extent for the higher operative mortality for women. Factors independently associated with perioperative mortality are generally similar for women and men.

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Metabolic syndrome may increase operative mortality in patients undergoing coronary artery bypass graft surgery

Future Lipidology ◽

10.2217/17460875.3.1.27 ◽

2008 ◽

Vol 3 (1) ◽

pp. 27-29 ◽

Cited By ~ 1

Author(s):

Steven R Tung ◽

Charles D Collard ◽

Wei Pan

Keyword(s):

Metabolic Syndrome ◽

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Operative Mortality ◽

Artery Bypass ◽

Bypass Graft ◽

Artery Bypass Graft

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Operative mortality with coronary artery bypass graft

Current Opinion in Cardiology ◽

10.1097/hco.0000000000000220 ◽

2015 ◽

Vol 30 (6) ◽

pp. 611-618 ◽

Cited By ~ 3

Author(s):

Donna May Kimmaliardjuk ◽

Hadi Toeg ◽

David Glineur ◽

Benjamin Sohmer ◽

Marc Ruel

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Operative Mortality ◽

Artery Bypass ◽

Bypass Graft ◽

Artery Bypass Graft

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Female Gender Is an Independent Predictor of Operative Mortality After Coronary Artery Bypass Graft Surgery

Circulation ◽

10.1161/circulationaha.104.525139 ◽

2005 ◽

Vol 112 (9_supplement) ◽

Author(s):

Ron Blankstein ◽

R. Parker Ward ◽

Morton Arnsdorf ◽

Barbara Jones ◽

You-Bei Lou ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Operative Mortality ◽

Independent Predictor ◽

Artery Bypass ◽

Bypass Graft ◽

Female Gender ◽

Artery Bypass Graft ◽

Significant Difference

Background— Women have a higher operative mortality (OM) after coronary artery bypass graft (CABG) surgery than men. Suggested contributing factors have included women’s increased age, advanced disease, comorbidities, and smaller body surface area (BSA). It is unclear whether women’s increased risk factors fully account for this difference or whether female gender within itself is associated with increased OM. We attempted to determine whether, all other factors being equal, there is a significant difference in OM between men and women undergoing CABG. Methods and Results— We retrospectively reviewed a clinical database of 15,440 patients who underwent CABG at 31 Midwestern hospitals in 1999–2000. Each patient record consisted of >400 data elements. Risk-adjusted mortality rates were computed using a predictive equation derived by stepwise logistic regression. Overall, women were older, had a higher incidence of diabetes and valvular disease, and were more likely to be presenting in shock. The OM for the entire population was 2.88% (women 4.24% versus men 2.23%, P <0.0001). Lower BSA was found to be an independent predictor of increased mortality, and a direct inverse relationship between BSA and OM was noted. After adjusting for all comorbidities including BSA, female gender remained an independent predictor of increased mortality (risk-adjusted OM was 3.81% for women and 2.43% for men). Thus, whereas risk adjustment reduced women’s OM from 90% higher than men’s to 22% higher, a significant difference remained. Conclusions— In this contemporary data set from 31 Midwestern hospitals, female gender was an independent predictor of perioperative mortality, even after accounting for all comorbidities, including low BSA.

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