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Preoperative prediction of early mortality in redocoronary artery surgery
Frans M van Eck1, Luc Noyez, Freek W A Verheugt
1Department of Thoracic and Cardiac Surgery -414-, Heartcenter, University Nijmegen Medical Center, St. Radboud, The Netherlands.
Objectives:
Construct a predictive model for early mortality in coronary reoperations (RECABG).
Methods:
Five hundred and forty one RECABG (1987-1998) were studied by univariate and multivariate analysis. Stepwise selective procedure (p<0.05) was used to identify a subset of variables with prognostic value for early mortality. This subset was used to calculate a prognostic score 'S' and a predicted probability 'P' for early mortality, P=1/1+e(-S). Sensitivity analysis was used for evaluation.
Results:
The best predictive variables for early mortality were diabetes, vascular-, lung-disease, a myocardial infarction between the primary and the RECABG, acute- and emergency operation and the operative period. The prognostic accuracy (receiver operating characteristics curve (ROC) area) was 80%. Observed probabilities compare well with the predicted probabilities, and patients were classified in low risk (5%), intermediate risk (15%), high risk (30%) and very high risk (40%). A predicted probability of > or =0.40 was used as cut-off point for the prognostic test. The specificity of this test was 97%, sensitivity 33%, predictive value of a positive test 63% and 90% for a negative test.
Conclusions:
The results show that individual patients presented for RECABG, can be stratified according to their early mortality risk. This information can be used to inform the patient, and also to discus the opportunity of the RECABG.