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Published on: March 27, 2018
Risk score for predicting long-term mortality after coronary artery bypass graft surgery
Chuntao Wu1, Fabian T Camacho, Andrew S Wechsler
1Department of Public Health Sciences, Penn State Hershey College of Medicine, Academic Support Bldg, Ste 2200, A210, 600 Centerview Dr, ASB 2200, Hershey, PA 17033, USA. chuntao.wu@psu.edu
Insights
A new simplified risk score accurately predicts long-term mortality after coronary artery bypass graft (CABG) surgery. This tool aids in patient consent and treatment decisions for CABG patients.
Area of Science:
- Cardiovascular Surgery
- Medical Informatics
- Public Health
Background:
- No validated bedside risk scores exist for predicting long-term mortality following coronary artery bypass graft (CABG) surgery.
- Accurate risk prediction is crucial for patient management and informed decision-making in cardiac surgery.
Purpose of the Study:
- To develop and validate a simplified bedside risk score for predicting long-term mortality after isolated CABG surgery.
- To assess the score's utility in clinical practice, including informed consent and treatment choice.
Main Methods:
- Utilized data from 8,597 patients undergoing isolated CABG surgery (2000) from the New York State Cardiac Surgery Reporting System.
- Employed a Cox proportional hazards model to identify preprocedural predictors of death, using National Death Index data through 2007.
- Assigned points to significant risk factors to create a simplified score, calculating predicted mortality at 1, 3, 5, and 7 years.
Main Results:
- Identified key predictors of mortality including age, ejection fraction, comorbidities (e.g., diabetes, renal failure), and surgical factors.
- The developed risk score ranged from 0 to 28 points, with distinct point values for each predictor.
- Observed and predicted mortality rates at 1, 3, 5, and 7 years showed high correlation across different patient risk strata.
Conclusions:
- The simplified risk score demonstrates high accuracy in predicting long-term mortality after CABG surgery.
- This validated score can serve as a valuable tool for enhancing informed consent processes.
- The score can assist clinicians in making more informed treatment choices for patients considering or undergoing CABG.
Background:
No simplified bedside risk scores have been created to predict long-term mortality after coronary artery bypass graft surgery.
Methods And Results:
The New York State Cardiac Surgery Reporting System was used to identify 8597 patients who underwent isolated coronary artery bypass graft surgery in July through December 2000. The National Death Index was used to ascertain patients' vital statuses through December 31, 2007. A Cox proportional hazards model was fit to predict death after CABG surgery using preprocedural risk factors. Then, points were assigned to significant predictors of death on the basis of the values of their regression coefficients. For each possible point total, the predicted risks of death at years 1, 3, 5, and 7 were calculated. It was found that the 7-year mortality rate was 24.2 in the study population. Significant predictors of death included age, body mass index, ejection fraction, unstable hemodynamic state or shock, left main coronary artery disease, cerebrovascular disease, peripheral arterial disease, congestive heart failure, malignant ventricular arrhythmia, chronic obstructive pulmonary disease, diabetes mellitus, renal failure, and history of open heart surgery. The points assigned to these risk factors ranged from 1 to 7; possible point totals for each patient ranged from 0 to 28. The observed and predicted risks of death at years 1, 3, 5, and 7 across patient groups stratified by point totals were highly correlated.
Conclusion:
The simplified risk score accurately predicted the risk of mortality after coronary artery bypass graft surgery and can be used for informed consent and as an aid in determining treatment choice.
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