OC05 BLEEDING RISK PREDICTION IN CORONARY ARTERY BYPASS SURGERY

Abstract

Abstract Background And Aim: Severe perioperative bleeding after coronary-artery bypass grafting(CABG) is associated with poor outcome. Recently new scores for prediction of severe bleeding have been developed. Aim of our study was to evaluate the reliability of 10 risk scores for bleeding in our cohort of CABG patients. Methods: An observational study included 337 consecutive patients who underwent isolated CABG from July2015 to January2018. Each bleeding risk score was calculated and analyzed through the c-statistic for Discrimination, the Hosmer-Lemeshow test for calibration. Results: The mean chest tube loss within the first 12 post-operative hours was 385.8 ± 222.0 ml. 1.7 ± 2.3 units of red blood cells per patient were transfused after the operation. Re-sternotomy for bleeding rate was 2.1%. The rate of severe-massive bleeding according to Universal Definition of Perioperative Bleeding(UDPB grades 3–4) classification was 15.1%. Overall in-hospital mortality was 2.6%. Mortality rates in patients with severe bleeding according to UDPB classification vs no-severe bleeding was 11.8% vs 1.1%(p < 0.0001) and UDPB 3–4 was associated with in-hospital mortality (OR 12.58,95% CI:3.20–61.29,p = 0.0005). Risk scores Discrimination was: 0.66 (0.58–0.74) for the ACTION, 0.63 (0.54–0.71) for the WILL-BLEED, 0.61 (0.52–0.67) for the TRACK, 0.59 (0.51–0.67) for the HEMORR2AGES, 0.59 (0.50–0.68) for the TRUST, 0.58 (0.49–0.66) for the ORBIT, 0.53 (0.443–0.621) for the HAS-BLED, 0.53 (0.43–0.62) for the CRUSADE, 0.52 (0.44–0.60) for the ATRIA and 0.51 (0.43–0.59) for the PAPWORTH. Calibration was adequate for all scores but the TRUST. Conclusions: In our cohort of CABG patients severe bleeding correlated with early mortality. While the ACTION score had the highest Discrimination, all the other scores analyzed successfully predicted severe perioperative bleeding after CABG.