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Published on: March 27, 2018
A three-group model to predict mortality in emergent coronary artery bypass graft surgery
Bernhard C Danner1, Vassilios N Didilis, Tomislav Stojanovic
1Department of Thoracic and Cardiovascular Surgery, University of Göttingen, Göttingen, Germany. drdanner@arcor.de
Insights
Emergent coronary artery bypass graft surgery for acute myocardial infarction poses high operative risk. The European System for Cardiac Operative Risk Evaluation (EuroSCORE) overestimates mortality, but creatine kinase-MB/h-ratio and ST-segment elevation improve risk prediction.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Risk Assessment
Background:
- Emergent coronary artery bypass graft (CABG) surgery for acute myocardial infarction (AMI) carries significant operative risk.
- The European System for Cardiac Operative Risk Evaluation (EuroSCORE) is used for mortality risk estimation but may be less accurate for high-risk patients.
- Additional cardiac data may enhance mortality risk prediction in complex cases.
Purpose of the Study:
- To evaluate the accuracy of the EuroSCORE in predicting in-hospital mortality for patients undergoing emergent CABG for AMI.
- To identify additional preoperative cardiac predictors of mortality in this patient population.
- To refine risk stratification for emergent CABG in AMI patients.
Main Methods:
- Retrospective review of patient data for emergent CABG and AMI over a 3-year period.
- Univariate and multivariate analyses were conducted to identify predictors of in-hospital mortality.
- EuroSCORE analysis and patient follow-up were performed to assess predictive accuracy.
Main Results:
- Overall in-hospital mortality was 18.3%.
- Independent preoperative risk factors identified included age, cardiogenic shock, and pulmonary hypertension.
- The EuroSCORE correlated with mortality but generally overestimated the risk, with observed mortalities of 3.3% (intermediate), 20.0% (high), and 63.2% (very high risk groups).
- Creatine kinase-myocardial band/hour ratio and ST-segment elevation were identified as additional risk factors in specific EuroSCORE groups.
Conclusions:
- Emergent CABG for AMI is associated with elevated operative risk.
- The Logistic EuroSCORE tends to overestimate mortality rates in these patients.
- Creatine kinase-MB/h-ratio and ST-segment elevation can improve the accuracy of operative risk prediction in defined EuroSCORE risk groups.
Background:
Emergent coronary artery bypass graft surgery (CABG) for acute myocardial infarction is associated with an increased operative risk. For estimation of mortality risk, the European System for Cardiac Operative Risk Evaluation (EuroSCORE) is appropriate up to a medium risk score (<6 points). To predict mortality risk more accurately in cases of higher EuroSCORE, additional cardiac data can be helpful.
Methods:
Over a 3-year period, patient data including acute myocardial infarction and emergent CABG were retrospectively reviewed. Univariate and multivariate analysis for in-hospital mortality was performed. The EuroSCORE analysis and follow-up was investigated.
Results:
Overall in-hospital mortality was 18.3%. Preoperative cardiac related predictors for in-hospital mortality were cardiogenic shock (p < 0.001), very poor left ventricular function (p = 0.001), and ST-segment elevation (p = 0.012). In multivariate regression analysis, age, cardiogenic shock, and pulmonary hypertension were independent preoperative risk factors. According to the EuroSCORE, we could define three statistically different groups: intermediate-risk, high-risk, and very high risk, with an observed mortality of 3.3%, 20.0%, and 63.2%, respectively. The EuroSCORE correlates with but overestimates the mortality risk. In subgroup analysis, the creatine kinase-myocardial band/hour ratio for the intermediate-risk group and ST-segment elevation for the high-risk group were additional cardiac risk factors.
Conclusions:
Patients with an acute myocardial infarction and emergency aortocoronary CABG have an elevated operative risk. Logistic EuroSCORE overestimates the mortality rate. Three different risk groups can be defined, in which creatine kinase-MB/h-ratio and ST-segment elevation can more accurately predict operative risk.
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