Outcomes and risk-profiles of patients undergoing isolated CABG-surgery. Are preoperative scores (Euro-Score versus KCH-Score) reliable predictors of the in hospital lethality?

Résumé fourni par la source

Objective: Preoperative scores are common indicators for the individual risk of each patient undergoing heart surgery. Aim of our study was to find out, whether certain risk-factors within the scoring systems significantly influence adverse outcomes and whether Euro- or KCH-Score reliably predict the outcomes of CABG patients. Methods: Preoperative risk-factors and scores, number of anastomoses, kind of grafts and in hospital lethality of patients undergoing isolated CABG-surgery were listed and compared. Results were obtained by HCH-Info, a database for cardiovascular departments. Statistical significance was calculated by X-Square-Test. Results: From 1/2003 to 5/2007 isolated CABG was performed in 1656 patients (women 18,4%) In 92,5% at least one artery, in 34,4% a T-graft (BIMA) procedure was performed. Mean number of anastomoses: 3,8/patient (T-grafts 4,1/patient). Mean age was 66,7yrs. Score-relevant risk factors as recent MI (p=0,0001), emergent operation (p==,0001), poor left ventricle (p=0,001), Creatinine >200 (p=0,002), critical preoperative state (p=0,0001), redo-operation (p=0,0001) and neurological dysfunction (p=0,007) occured significantly higher in the group of those patients who died in hospital. Euro-Score calculated in hospital lethality to be 8,2% ((T-grafts 4,0%), KCH-Score 3,9% (T-grafts 1,8%) whereas the observed in hospital lethality in our patients just was 2,9% (T-grafts 1,4%) Conclusion: The Score-items with the highest odds-ratios do have a predictive influence on patient's postoperative outcomes. Today the odds ratios of the logistic Euro-Score are too high, so that the calculated in hospital lethality does not reflect reality whereas the new KCH-Score reliably predicts patient's individual risk to die in hospital after CABG surgery.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.