Predictive value of the additive and logistic EuroSCOREs in patients undergoing aortic valve replacement.

OBJECTIVES: The purpose of this study was to evaluate the accuracy of the additive and logistic EuroSCOREs in predicting the operative mortality in patients undergoing aortic valve replacement (AVR) with or without coronary artery bypass graft (CABG) surgery. DESIGN: This was a retrospective analysis of prospectively collected data. SETTING: This was a single-center study performed in an educational hospital. PARTICIPANTS: All patients (n = 1,885) who underwent AVR with (n = 813) or without (n = 1,072) CABG surgery between 1998 and 2007. INTERVENTIONS: AVR with or without CABG surgery. MEASUREMENTS AND MAIN RESULTS: Variable life-adjusted display curves were constructed to compare the observed operative mortality with the additive and logistic EuroSCOREs. The receiver operating characteristics (ROC) curve was used to determine the discriminatory power of the additive and logistic EuroSCOREs. Calibration between the predicted and the observed operative mortality was checked by comparing the predicted probability of the mortality with the additive and logistic EuroSCORE. In the isolated AVR group, the additive EuroSCORE was 5.8% predicted mortality and the logistic EuroSCORE was 7.2%, whereas the observed operative mortality was 3.2%. In the AVR with CABG surgery group, the additive EuroSCORE was 7.2% and the logistic EuroSCORE was 8.8%, whereas the observed operative mortality was 5.3%. ROC curve analyses showed a high discriminatory power for both EuroSCOREs in both patient groups. CONCLUSIONS: Although the additive and the logistic EuroSCOREs had good discriminatory power, they were not able to predict the actual operative mortality accurately. Both EuroSCOREs overestimated the operative mortality, especially in low-risk patients.

Preoperative hemoglobin level as a predictor of survival after coronary artery bypass grafting: a comparison with the matched general population.

BACKGROUND: The predictive value of the preoperative hemoglobin value after coronary artery bypass grafting (CABG) has not been well established. We studied how the preoperative hemoglobin level affects the survival of patients after CABG. Late mortality was compared with that of a general population. METHODS AND RESULTS: Early and late mortality of all consecutive patients undergoing isolated CABG between January 1998 and December 2007 were determined. Patients were classified into 4 groups stratified by preoperative hemoglobin level. The cutoff point for anemia was 13 g/dL for men and 12 g/dL for women. Expected survival of a matched general Dutch population cohort was obtained from the database of the Dutch Central Bureau for Statistics. After the exclusion of 122 patients who were lost to follow-up and 481 patients with missing preoperative hemoglobin levels, complete data were obtained in 10,025 patients. Multivariate logistic regression analyses revealed anemia to be an independent risk factor for higher early mortality. Cox regression analyses revealed low hemoglobin level, both as a continuous variable and as a dichotomous variable (anemia), to be a predictor of higher late mortality. Compared with expected survival, patients with the lowest preoperative hemoglobin levels had a worse outcome, whereas patients with the highest hemoglobin levels had a better outcome. CONCLUSIONS: A lower preoperative hemoglobin level is an independent predictor of late mortality in patients undergoing CABG, whereas anemia is a risk factor for early and late mortality. Compared with the general population, anemic patients had worse survival than expected, whereas nonanemic patients had better survival than expected.

Risk factors for red blood cell transfusion after coronary artery bypass graft surgery.

OBJECTIVES: Perioperative transfusion of red blood cells is associated with increased morbidity and mortality. The authors investigated the correlation between preoperative risk factors and the number of red blood cell units received in patients undergoing coronary artery bypass graft surgery. DESIGN: A retrospective analysis of prospectively collected data. SETTING: A single-center study performed in an educational hospital. PARTICIPANTS: All patients who underwent isolated coronary artery bypass graft surgery between 1998 and 2007 (N = 10,626) were included. INTERVENTIONS: Isolated coronary artery bypass graft surgery. MEASUREMENTS AND MAIN RESULTS: Univariate and multivariate logistic regression analyses were performed to investigate the impact of preoperative and perioperative factors on transfusion of 1 or more units of red blood cells. The following independent risk factors for receiving red blood cell units were identified: age, female sex, low body surface area, low left ventricular ejection fraction (<35%), emergency operation, previous cardiac surgery, low preoperative hemoglobin, and low preoperative creatinine clearance. Perioperative risk factors were the use of extracorporeal circulation, longer bypass time, use of crystalloid cardioplegia, the need for intra-aortic balloon pump, perioperative myocardial infarction, and re-exploration for any cause. CONCLUSIONS: In this study, the authors identified risk factors for receiving red blood cells in patients undergoing coronary artery bypass graft surgery. The authors were able to implement these factors in their daily practice by sharpening the criteria for the direct availability of red blood cells in the operating room.

Preoperative C-reactive protein levels to predict early and late mortalities after coronary artery bypass surgery: eight years of follow-up.

OBJECTIVE: There is limited evidence that increased preoperative levels of C-reactive protein are associated with increased mortality after coronary artery bypass grafting. We retrospectively investigated in 5669 patients the predictive value of preoperative C-reactive protein levels for early and late mortalities after coronary artery bypass grafting. METHODS: Patients undergoing isolated coronary artery bypass grafting between January 2000 and December 2007 (n = 8500) were studied. Preoperative demographic data and risk factors and outcome data (mortality data) were prospectively collected in a database. Preoperative C-reactive protein levels were retrieved from the laboratory data. RESULTS: In 5669 of 8500 cases, the preoperative C-reactive protein level could be retrieved. Seventy-five patients were unavailable for follow-up. A preoperative C-reactive protein level greater than 10 mg/L was an independent risk factor for early mortality, whereas a level greater than 5 mg/L was a risk factor for late mortality. Other risk factors were age, sex, chronic obstructive pulmonary disease, diabetes, left ventricular ejection fraction less than 35%, peripheral vascular disease, and previous cardiac surgery. We found a higher mean C-reactive protein value in patients with a left ventricular ejection fraction less than 35% (18.5 +/- 33 mg/L) than in those with an ejection fraction greater than 35% (P < .0001). CONCLUSIONS: Preoperative C-reactive protein levels can be used in risk stratification in coronary artery bypass grafting surgery. A C-reactive protein level greater than 10 mg/L is a risk factor for early mortality, whereas a level greater than 5 mg/L is a risk factor for late mortality.