BACKGROUND: The EuroSCORE associates coronary artery bypass graft (CABG) surgery with higher perioperative risk in the first 3 months after a myocardial infarction (MI). The optimal scheduling of CABG surgery after unstable angina (UA) is unknown. We investigated the preoperative predictors of adverse outcomes in patients undergoing CABG with prior MI or UA and investigated the importance of time interval between the cardiac event and CABG. METHODS: The Hospital Episode Statistics database (April 2006-March 2010) was analysed for elective admissions for CABG. Independent preoperative patient factors influencing length of stay, readmission rates, and mortality, were identified by logistic regression and presented as adjusted odds ratios (ORs). RESULTS: A total of 10 418 patients with prior MI (mortality 1.8%) and 5241 patients with prior UA (mortality 2.2%) were included in the respective cohorts. Multiple risk factors were identified in each population including liver disease and renal failure. The time interval from cardiac event (MI or UA) to elective CABG surgery did not influence perioperative outcomes when analysed as a continuous measure or using the arbitrary 3-month threshold [MI, OR 1.1 (0.78-1.57) and UA, OR 0.65 (0.39-1.09)]. CONCLUSIONS: Our hypothesis generating data suggest that the increased risk currently allocated in the EuroSCORE for an interval of 3 months between MI and CABG should be critically re-evaluated. Furthermore, prior MI should not be discounted as a risk factor if it is more than 3 months old.
BACKGROUND: The EuroSCORE associates coronary artery bypass graft (CABG) surgery with higher perioperative risk in the first 3 months after a myocardial infarction (MI). The optimal scheduling of CABG surgery after unstable angina (UA) is unknown. We investigated the preoperative predictors of adverse outcomes in patients undergoing CABG with prior MI or UA and investigated the importance of time interval between the cardiac event and CABG. METHODS: The Hospital Episode Statistics database (April 2006-March 2010) was analysed for elective admissions for CABG. Independent preoperative patient factors influencing length of stay, readmission rates, and mortality, were identified by logistic regression and presented as adjusted odds ratios (ORs). RESULTS: A total of 10 418 patients with prior MI (mortality 1.8%) and 5241 patients with prior UA (mortality 2.2%) were included in the respective cohorts. Multiple risk factors were identified in each population including liver disease and renal failure. The time interval from cardiac event (MI or UA) to elective CABG surgery did not influence perioperative outcomes when analysed as a continuous measure or using the arbitrary 3-month threshold [MI, OR 1.1 (0.78-1.57) and UA, OR 0.65 (0.39-1.09)]. CONCLUSIONS: Our hypothesis generating data suggest that the increased risk currently allocated in the EuroSCORE for an interval of 3 months between MI and CABG should be critically re-evaluated. Furthermore, prior MI should not be discounted as a risk factor if it is more than 3 months old.
Authors: Kim A Eagle; Robert A Guyton; Ravin Davidoff; Fred H Edwards; Gordon A Ewy; Timothy J Gardner; James C Hart; Howard C Herrmann; L David Hillis; Adolph M Hutter; Bruce Whitney Lytle; Robert A Marlow; William C Nugent; Thomas A Orszulak; Elliott M Antman; Sidney C Smith; Joseph S Alpert; Jeffrey L Anderson; David P Faxon; Valentin Fuster; Raymond J Gibbons; Gabriel Gregoratos; Jonathan L Halperin; Loren F Hiratzka; Sharon Ann Hunt; Alice K Jacobs; Joseph P Ornato Journal: Circulation Date: 2004-08-31 Impact factor: 29.690
Authors: Christian Vahlhaus; Joachim Neumann; Hartmut Lüss; Frauke Wenzelburger; Tony D T Tjan; Dieter Hammel; Hans H Scheld; Wilhelm Schmitz; Günter Breithardt; Thomas Wichter Journal: J Card Surg Date: 2005 Sep-Oct Impact factor: 1.620
Authors: Gregg W Stone; James H Ware; Michel E Bertrand; A Michael Lincoff; Jeffrey W Moses; E Magnus Ohman; Harvey D White; Frederick Feit; Antonio Colombo; Brent T McLaurin; David A Cox; Steven V Manoukian; Martin Fahy; Tim C Clayton; Roxana Mehran; Stuart J Pocock Journal: JAMA Date: 2007-12-05 Impact factor: 56.272
Authors: Jennifer F Waljee; David C Cron; Rena M Steiger; Lin Zhong; Michael J Englesbe; Chad M Brummett Journal: Ann Surg Date: 2017-04 Impact factor: 12.969
Authors: Dipak Kotecha; Marcus D Flather; Dan Atar; Peter Collins; John Pepper; Elizabeth Jenkins; Christopher M Reid; David Eccleston Journal: BMC Med Date: 2019-04-03 Impact factor: 8.775