Eeva-Maija Kinnunen1, Matti-Aleksi Mosorin1, Andrea Perrotti2, Vito G Ruggieri3, Peter Svenarud4, Magnus Dalén5, Francesco Onorati6, Giuseppe Faggian6, Giuseppe Santarpino7, Daniele Maselli7, Carmelo Dominici7, Saverio Nardella7, Francesco Musumeci8, Riccardo Gherli8, Giovanni Mariscalco9, Nicola Masala9, Antonino S Rubino10, Carmelo Mignosa10, Marisa De Feo11, Alessandro Della Corte11, Ciro Bancone11, Sidney Chocron2, Giuseppe Gatti12, Tatu Juvonen1, Fausto Biancari13. 1. Department of Surgery, Oulu University Hospital, Oulu, Finland. 2. Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France. 3. Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France. 4. Department of Molecular Medicine and Surgery, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. 5. Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy. 6. Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany. 7. Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy. 8. Unit of Cardiac Surgery, Department of Cardiosciences, Hospital S. Camillo-Forlanini, Rome, Italy. 9. Department of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester, United Kingdom. 10. Centro Cuore Morgagni, Pedara, Italy. 11. Division of Cardiac Surgery, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy. 12. Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy; Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France. 13. Department of Surgery, Oulu University Hospital, Oulu, Finland. Electronic address: faustobiancari@yahoo.it.
Abstract
OBJECTIVE: The authors aimed to validate the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) classification of postoperative complications in patients undergoing coronary artery bypass grafting (CABG). DESIGN: Retrospective, observational study. SETTING: University hospital. PARTICIPANTS: A total of 2,764 patients with severe coronary artery disease. Complete baseline, operative, and postoperative data were available for patients who underwent isolated CABG. INTERVENTIONS: Isolated CABG. MEASUREMENTS AND MAIN RESULTS: The E-CABG complication classification was used to stratify the severity and prognostic impact of adverse postoperative events. Primary outcome endpoints were 30-day, 90-day, and long-term all-cause mortality. The secondary outcome endpoints was the length of intensive care unit stay. Both the E-CABG complication grades and additive score were predictive of 30-day (area under the receiver operating characteristics curve 0.866, 95% confidence interval [CI] 0.829-0.903; and 0.876; 95% CI 0.844-0.908, respectively) and 90-day (area under the receiver operating characteristics curve 0.850, 95% CI 0.812-0.887; and 0.863, 95% CI 0.829-0.897, respectively) all-cause mortality. The complication grades were independent predictors of increased mortality at actuarial (log-rank: p<0.0001) and adjusted analysis (p<0.0001; grade 1: hazard ratio [HR] 1.757, 95% CI 1.111-2.778; grade 2: HR 2.704, 95% CI 1.664-4.394; grade 3: HR 5.081, 95% CI 3.148-8.201). When patients who died within 30 days were excluded from the analysis, this grading method still was associated with late mortality (p<0.0001). The grading method (p<0.0001) and the additive score (rho, 0.514; p<0.0001) were predictive of the length of intensive care unit stay. CONCLUSIONS: The E-CABG postoperative complication classification seems to be a promising tool for stratifying the severity and prognostic impact of postoperative complications in patients undergoing cardiac surgery.
OBJECTIVE: The authors aimed to validate the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) classification of postoperative complications in patients undergoing coronary artery bypass grafting (CABG). DESIGN: Retrospective, observational study. SETTING: University hospital. PARTICIPANTS: A total of 2,764 patients with severe coronary artery disease. Complete baseline, operative, and postoperative data were available for patients who underwent isolated CABG. INTERVENTIONS: Isolated CABG. MEASUREMENTS AND MAIN RESULTS: The E-CABG complication classification was used to stratify the severity and prognostic impact of adverse postoperative events. Primary outcome endpoints were 30-day, 90-day, and long-term all-cause mortality. The secondary outcome endpoints was the length of intensive care unit stay. Both the E-CABG complication grades and additive score were predictive of 30-day (area under the receiver operating characteristics curve 0.866, 95% confidence interval [CI] 0.829-0.903; and 0.876; 95% CI 0.844-0.908, respectively) and 90-day (area under the receiver operating characteristics curve 0.850, 95% CI 0.812-0.887; and 0.863, 95% CI 0.829-0.897, respectively) all-cause mortality. The complication grades were independent predictors of increased mortality at actuarial (log-rank: p<0.0001) and adjusted analysis (p<0.0001; grade 1: hazard ratio [HR] 1.757, 95% CI 1.111-2.778; grade 2: HR 2.704, 95% CI 1.664-4.394; grade 3: HR 5.081, 95% CI 3.148-8.201). When patients who died within 30 days were excluded from the analysis, this grading method still was associated with late mortality (p<0.0001). The grading method (p<0.0001) and the additive score (rho, 0.514; p<0.0001) were predictive of the length of intensive care unit stay. CONCLUSIONS: The E-CABG postoperative complication classification seems to be a promising tool for stratifying the severity and prognostic impact of postoperative complications in patients undergoing cardiac surgery.