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Major risk stratification models do not predict perioperative outcome after coronary artery bypass grafting in
Nikolaos Bonaros1, David Vill, Dominik Wiedemann
1Department of Cardiac Surgery, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria. nikolaos.bonaros@i-med.ac.at
Insights
Risk models like EuroSCORE and STS are inaccurate for predicting outcomes in patients undergoing coronary artery bypass grafting (CABG) after percutaneous coronary interventions (PCI). New models are needed for better risk assessment in these cardiac surgery patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Health Outcomes Research
Background:
- Risk stratification models are crucial for predicting perioperative outcomes in cardiac surgery.
- Patients with prior percutaneous coronary interventions (PCIs) represent a growing population undergoing coronary artery bypass grafting (CABG).
- The accuracy of existing risk models in this specific patient group remains uncertain.
Purpose of the Study:
- To evaluate the predictive accuracy of the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and the Society of Thoracic Surgeons (STS) risk model for perioperative outcomes in patients undergoing CABG with a history of PCI.
- To compare the performance of these models between patients with and without prior PCI.
Main Methods:
- Retrospective analysis of 367 patients with prior elective PCI and 2361 patients without prior PCI undergoing first-time isolated CABG (2001-2009).
- Assessment of perioperative mortality and morbidity.
- Receiver operating characteristic (ROC) analysis to determine the discriminatory power (Area Under the Curve - AUC) of EuroSCORE and STS models.
Main Results:
- Patients with prior PCI exhibited higher perioperative mortality (3.8% vs 2.1%) and major adverse cardiac events (8.4% vs 4.5%).
- Both EuroSCORE and STS models demonstrated significantly lower discriminatory power for predicting 30-day mortality and morbidity/mortality (M&M) in patients with prior PCI compared to those without.
- Logistic EuroSCORE failed to accurately predict 30-day mortality in the PCI group (AUC=0.552) but was accurate in the non-PCI group (AUC=0.875).
Conclusions:
- Current risk stratification models (EuroSCORE, STS) are inadequate for predicting perioperative mortality and morbidity in patients undergoing CABG with a history of prior PCI.
- There is a critical need to develop and validate modified risk assessment tools tailored for this complex patient cohort.
- Improved risk assessment is essential for optimizing surgical decision-making and patient management in patients with prior PCI undergoing CABG.
Objective:
To investigate whether common risk stratification models in cardiac surgery predict perioperative outcome of coronary artery bypass grafting (CABG) in patients with previous percutaneous coronary interventions (PCIs).
Methods:
We retrospectively analyzed the perioperative mortality and morbidity of 367 patients with prior elective PCI versus 2361 patients without prior PCI, who underwent first-time isolated CABG between 2001 and 2009 at our institution. Receiver operating characteristics (ROC) were used to describe the performance and accuracy of the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and the Society of Thoracic Surgeons (STS) risk model in predicting mortality and morbidity.
Results:
Both groups were comparable concerning preoperative logistic EuroSCORE (PCI: 4.9 ± 6.57, non-PCI: 4.60 ± 5.45, p=0.51). Patients with previous elective PCI had increased perioperative mortality (PCI: 3.8% vs non-PCI: 2.1%, p=0.01) and higher rates of major adverse cardiac events (8.4% vs 4.5% respectively, p=0.003). Discriminatory power for 30-day mortality was higher in the non-PCI group (EuroSCORE area under the curve (AUC): 0.875 vs 0.552 in the PCI group). Logistic EuroSCORE predicted 30-day mortality in the non-PCI group (confidence interval (CI)=0.806-0.934, p=0.0004) but not in the PCI group (CI=0.301-0.765, p=0.8). Discriminatory power for morbidity or mortality (M&M) was lower in the PCI group (AUC: 0.980 vs 0.713 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, p<0.001).
Conclusions:
The EuroSCORE and the STS risk model were inaccurate in predicting perioperative mortality after CABG in patients with history of elective PCI. There is a need for modification of risk models to improve risk assessment for surgical candidates with prior PCI.
