Current Predictors of Risk in Coronary Surgery

pp 284-293

Abstract

It is mandatory to know the result in the risk-benefit ratio equation in coronary surgery treatment (CRM)in our patients. The aim of this study is: a) analyze the results in CRM in our population, b) identify of independent predictors of mortality and morbidity in CRM and c) analyze the surgical risk in patients with left main coronary stenosis, acute coronary syndromes and coronary reoperations.

Methods

We included 709 patients operated on betweenJanuary 1997 and April 2000 in the "Institute Cardiovascular of Buenos Aires" (ICBA) whose CRM was performed as an isolated type of treatment. Non-parametric tests were used for continuous variables and chit test for discontinuous ones. Multi-variable logistic regression analysis was used to identify independent predictors for hospital mortality and morbidity.

Results

The mean age was 62.9 ± 9.6 years old and 87% of the patients were male. Twenty-nine percent of the patients were older than 70. Overall mortality for CRM was 3.5% (25/709) and 1% (5/493) for elective surgery. Multivariate analysis identified the following independent predictors:a)for hospital mortality: shock p < 0.0001, odds ratio: 28.37 (CI 95% 7.05-114.1); failed PTVCA p = 0.0045, odds ratio 7.80 (CI95% 1.89-32.1); progressive angina p = 0.0012, odds ratio 4.82 (CI 95% 1.86-12.4); reoperation CRM p =0.016, odds ratio 3.26 (CI 95%1.2-8.5);b) for hospital morbidity:previous renal failure p = 0001, odds ratio 5.06 (CI 95% 1.40-18.25); emergency CRM p =0.007, odds ratio 4.28 (CI 95% 1.48-12.34); diabetes p= 0.0002, odds ratio 2.49 (CI 95% 1.53-4.07). The mortality for patients operated with acute coronary syndromes was 6.2% (n = 64) and the mortality for reoperation CRM was 13% (7/52) and for elective reoperation CRM was 9% (0/29) (p = NS).

Conclusions

CRM results in the ICBA are in agreement to those in international reports. Patients with shock failed PTCA, progressive angina and with previous CRM faced higher risk for hospital mortality, and patients with diabetes, previous renal failure andCRM during emergency had increased incidence for postoperative complications.