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The Prognostic Significance of Different Bleeding Classifications in off-pump coronary artery bypass grafting
Ziwei Xi1, Yanan Gao1, Zhenxian Yan1
1Department of Cardiology, Beijing Anzhen hospital, Capital Medical University, Anzhen Road, Chaoyang District, Beijing, 100029, China.
Insights
Perioperative bleeding classifications like BARC, E-CABG, and UDPB predict adverse outcomes in off-pump coronary artery bypass grafting (OPCAB) patients. These validated tools aid in assessing bleeding severity and patient prognosis.
Area of Science:
- Cardiovascular Surgery
- Critical Care Medicine
- Clinical Outcomes Research
Background:
- Perioperative bleeding in cardiac surgery increases risks of adverse outcomes.
- Several bleeding classifications exist, requiring further validation.
- Prognostic value of different bleeding classifications in OPCAB needs exploration.
Purpose of the Study:
- To validate and explore the prognostic value of different bleeding classifications.
- To assess the association of major bleeding with in-hospital death, myocardial infarction, and acute kidney injury.
- To determine if bleeding classifications improve predictive models for adverse events.
Main Methods:
- Retrospective analysis of 3988 OPCAB patients.
- Evaluation of Bleeding Academic Research Consortium (BARC), Universal Definition of Perioperative Bleeding (UDPB), European registry of Coronary Artery Bypass Grafting (E-CABG), and Study of Platelet Inhibition and Patient Outcomes (PLATO) classifications.
- Multivariable logistic regression and goodness-of-fit tests to assess associations and predictive performance.
Main Results:
- BARC type 4, UDPB class 4, and E-CABG classes 2-3 were associated with increased risk of in-hospital death and myocardial infarction.
- Major bleeding by all four classifications independently predicted acute kidney injury.
- Incorporating bleeding classifications improved the predictive model for adverse events.
Conclusions:
- BARC, E-CABG, and UDPB classifications are significantly associated with poorer immediate outcomes after OPCAB.
- These classifications are valuable tools for assessing the prognostic impact of perioperative bleeding.
- Validated bleeding classifications enhance risk stratification and prediction of adverse events in cardiac surgery patients.
Background:
Perioperative bleeding during cardiac surgery are known to make patients susceptible to adverse outcomes and several bleeding classifications have been developed to stratify the severity of bleeding events. Further validation of different classifications was needed. The aim of present study was to validate and explore the prognostic value of different bleeding classifications in patients undergoing off-pump coronary artery bypass grafting (OPCAB).
Methods:
Data on baseline and operative characteristics of 3988 patients who underwent OPCAB in Beijing Anzhen Hospital from February 2008 to December 2014 were available. The primary endpoint was a composite of in-hospital death and nonfatal postoperative myocardial infarction (MI). The secondary endpoint was postoperative acute kidney injury (AKI). We explored the association of major bleeding defined by the European registry of Coronary Artery Bypass Grafting (E-CABG), Universal Definition of Perioperative Bleeding (UDPB), Bleeding Academic Research Consortium (BARC) classification and Study of Platelet Inhibition and Patient Outcomes (PLATO) with primary endpoints by multivariable logistic regression analysis and investigated their significance of adverse event prediction using goodness-of-fit tests of - 2 log likelihood.
Results:
In-hospital mortality was 1.23% (n = 49) and postoperative MI was observed in 4.76% (n = 190) of patients, AKI in 24.69% (n = 985). The incidence of the primary outcome was 5.99% (n = 239). Multivariable logistic regression analysis showed that BARC type 4 (OR = 2.64, 95% CI: 1.66-4.19, P < 0.001), UDPB class 4 (OR = 3.52, 95% CI: 2.05-6.02, P < 0.001) and E-CABG class 2-3 (class 2: OR = 2.24, 95% CI: 1.36-3.70, P = 0.001; class 3: OR = 12.65, 95% CI: 2.74-18.43, P = 0.002) bleeding but not PLATO bleeding were associated with an increased risk of in-hospital death and postoperative MI. Major bleeding defined by all the four classifications mentioned above was an independent risk factor of AKI after surgery. Inclusion of major bleeding defined by these four classifications improved the predictive performance of the multivariable model with baseline characteristics.
Conclusions:
Bleeding assessed by BARC, E-CABG and UDPB classifications were significantly associated with poorer immediate outcomes. These classifications seemed to be valuable tool in the assessment of prognostic effect of perioperative bleeding.
