Abstract
Background: Off-pump coronary artery bypass grafting (OPCAB) comprises 15–30% of all bypass grafting surgeries. The currently available perioperative scores such as Euroscore and STS score do not specifically predict long-term mortality after off-pump procedures. The neutrophil-to-lymphocyte ratio (NLR) is one of the new, easily accessible markers of inflammation with proven predictive value in cardiovascular diseases. We aimed to develop the first risk score for long-term mortality after OPCAB and to determine if the perioperative value of NLR predicts long-term mortality in OPCAB patients. Methods: In total, 440 consecutive patients with multivessel stable coronary artery disease undergoing OPCAB were recruited. Differential leukocyte counts were obtained by a routine hematology analyzer. Data regarding mortality during a median follow-up time of 5.3 years were obtained from the Polish National Health Service database. An independent population of 242 patients served as a validation cohort. Results: All-cause mortality was influenced by different clinical risk factors. In multivariate regression analysis, chronic obstructive pulmonary disease, stroke history, post-operative NLR and LVEF were independent predictors of mortality. Combing all independent predictors predicted long-term all-cause mortality with 68.5% sensitivity and 71.5% specificity (AUC = 0.704, p < 0.001). After weighing these variables according to their estimates in a multivariate regression model, we developed a score to predict mortality in patients undergoing OPCAB (PREDICT-OPCAB Score, ranging from 0 to 10). Patients with a high score were at higher risk of mortality within the median 5.3 years of follow-up (score 0–3: 8.3%; 4–6: 27.0%; 7–10: 40.0%; p < 0.001 for score 0–3 vs. 4–6 and 7–10). This association was confirmed in the validation cohort. Conclusions: We developed and validated the first simplified risk score to predict mortality following OPCAB based on easily accessible clinical factors. This risk score can be used when obtaining a patient’s informed consent and as an aid in determining treatment.
Highlights
The main finding of this study is the creation of constitutive disease excluding acute main finding of thisat study is the creation is ofan factors, considering that the postoperative value measured hospital discharge constitutive factors, considering that the postoperative value measured at hospital independent predictor of long-term mortality after Off-pump coronary artery bypass grafting (OPCAB)
chronic obstructive pulmonary disease (COPD) severity, our results indicate that COPD is associated with a Whereas focused on the risk of post-operative stroke after CABG [22,23], two-fold higher numerous long-termstudies mortality
We developed and validated the first simplified risk score to predict mortality following OPCAB based on accessible clinical factors
Summary
Coronary artery bypass grafting (CABG) surgery remains the gold standard to treat multivessel coronary artery disease (MVD) with high lesion complexity due to its survival advantage over percutaneous coronary interventions (PCI) [1]. Surgical revascularization can be performed with (on-pump) or without (off-pump) cardiopulmonary bypass application, with satisfactory outcomes [2]. Off-pump coronary artery bypass grafting (OPCAB) comprises 15–30% of all CABG cases, based on different national registries [2,3]. Whereas the short-term patency of grafts is excellent [4], the risk of long-term graft failure ranges from 10 to 15% for arterial grafts and from 20 to 40% for venous grafts up to 9 years following surgery [5]
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