Major risk stratification models do not predict perioperative outcome after coronary artery bypass grafting in patients with history of elective percutaneous intervention

  • N. B
  • D. H
  • T. S
  • et al.
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Abstract

Objective: The number of patients with previous Percutaneous Coronary Interventions (PCI) referred to Coronary Artery Bypass Grafting (CABG) is continuously increasing. There is evidence that previous elective PCI has a negative impact on perioperative outcome. The aim of the study was to investigate whether risk stratification models predict perioperative outcome of CABG in those patients. Methods: We retrospectively analyzed perioperative mortality and morbidity of 306 patients with prior elective PCI versus a matched population of 452 patients without prior PCI, who underwent first-time isolated elective CABG between 2002 and 2007 at our institution. Receiver operating characteristics (ROC) were used to describe the performance and accuracy of EuroSCORE, and STS Risk Model in predicting mortality and morbidity. Results: Both groups were comparable concerning preoperative linear EuroSCORE (PCI: 4.83+/-0.18, non-PCI: 4.72+/-0.14, p=0.63). Patients with previous elective PCI had increased perioperative mortality (PCI: 3.3% vs non PCI: 1.9%, p<0.001) and MACEs (7.9% vs 4.3% respectively, p<0.001). Discriminatory power for 30-day mortality was higher in the non-PCI group (EuroSCORE AUC: 0.875 vs 0.552 in the PCI group). Logistic EuroSCORE predicted 30-day mortality in the non-PCI (CI=0.806-0.934, p<0.001 but not in the PCI group (CI= 0.301-0.765, p=803). Discriminatory power for morbidity or mortality (M&M) and perioperative myocardial infarction (MI) was lower in the PCI group (M&M AUC: 0.980 vs. 0.713 for the non-PCI group, and perioperative MI AUC:0.713 for the PCI vs 0.980 for the non PCI group). The STS risk model had a lower discriminatory power for predicting M&M in PCI patients (AUC: 0.611, vs 0.686 for the non PCI group). Conslusions: EuroSCORE and STS risk model failed to predict perioperative mortality after CABG in patients with history of PCI. Discriminatory power of risk stratification models is lower in those patients. There is a need for modification of current risk stratification models in order to improve risk assessment for surgical candidates with prior PCI.

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N., B., D., H., T., S., A., K., G., F., L., M., … J., B. (2009). Major risk stratification models do not predict perioperative outcome after coronary artery bypass grafting in patients with history of elective percutaneous intervention. European Heart Journal, 30, 916. Retrieved from https://academic.oup.com/eurheartj/pdf-lookup/30/Supplement 1/845 https://doi.org/10.1093/eurheartj/ehp416 http://ovidsp.ovid.com/athens/ovidweb.cgi?T=JS&PAGE=fulltext&MODE=ovid&CSC=Y&NEWS=N&D=ovft&SEARCH=0195-668X.is+and+%252230%2522.vo+and+%2522Suppleme

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