Predicting operative mortality in octogenarians for isolated coronary artery bypass grafting surgery: a retrospective study

BMC Cardiovascular Disorders

Research Article

Yugmel S. Nijjar¹  Jessica G. Y. Luc¹  Sadek Al Shouli²  Steven R. Meyer²  Colleen M. Norris³  Michelle M. Graham⁴ 

[1] Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada;Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada;Mazankowski Alberta Heart Institute, Edmonton, Canada;Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada;Mazankowski Alberta Heart Institute, Edmonton, Canada;Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada;Mazankowski Alberta Heart Institute, Edmonton, Canada;Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada;

关键词: Cardiovascular research;    Coronary artery disease;    Risk prediction;    Octogenarians;    Cardiovascular Surgery;    Coronary Artery Disease;    Risk Stratification;   

DOI  :  10.1186/s12872-017-0706-z

 received in 2017-03-28, accepted in 2017-10-18,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundAvailable cardiac surgery risk scores have not been validated in octogenarians. Our objective was to compare the predictive ability of the Society of Thoracic Surgeons (STS) score, EuroSCORE I, and EuroSCORE II in elderly patients undergoing isolated coronary artery bypass grafting surgery (CABG).MethodsAll patients who underwent isolated CABG (2002 – 2008) were identified from the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) registry. All patients aged 80 and older (n = 304) were then matched 1:2 with a randomly selected control group of patients under age 80 (n = 608 of 4732). Risk scores were calculated. Discriminatory accuracy of the risk models was assessed by plotting the areas under the receiver operator characteristic (AUC) and comparing the observed to predicted operative mortality.ResultsOctogenarians had a significantly higher predicted mortality by STS Score (3 ± 2% vs. 1 ± 1%; p < 0.001), additive EuroSCORE (8 ± 3% vs. 4 ± 3%; p < 0.001), logistic EuroSCORE (15 ± 14% vs. 5 ± 6%; p < 0.001), and EuroSCORE II (4 ± 3% vs. 2 ± 2%; p < 0.001) compared to patients under age 80 years. Observed mortality was 2% and 1% for patients age 80 and older and under age 80, respectively (p = 0.323). AUC revealed areas for STS, additive and logistic EuroSCORE I and EuroSCORE II, respectively, for patients age 80 and older (0.671, 0.709, 0.694, 0.794) and under age 80 (0.829, 0.750, 0.785, 0.845).ConclusionAll risk prediction models assessed overestimated surgical risk, particularly in octogenarians. EuroSCORE II demonstrated better discriminatory accuracy in this population. Inclusion of new variables into these risk models, such as frailty, may allow for more accurate prediction of true operative risk.

【 授权许可】

CC BY   
© The Author(s). 2017