Coronary Artery Bypass Graft Surgery Mortality Research Articles

Rates of revascularization and PCI:CABG ratio: a new indicator predicting in-hospital mortality in acute coronary syndromes.

The principal trend in acute coronary syndrome (ACS) is increasing utilization of percutaneous coronary interventions (PCI) and declining coronary artery bypass graft surgery (CABG) utilization. This study was designed to evaluate whether higher PCI:CABG ratios lead to higher in-hospital PCI or CABG mortality. The National Readmission Database for years 2016 was queried for all hospitalized ACS patients who underwent coronary revascularization during their admission. The study population was derived from 355 US hospitals and included 103 021 patients. Hospitals were grouped based on their PCI:CABG ratio into low, intermediate, and high ratio quartiles with a median [interquartile ranges (IQR)] PCI:CABG ratio of 2.9 (2.5-3.2), 5.0 (4.3-5.9) and 8.9 (7.8-10.3), respectively multivariable logistic regression with adjustment for age, demographics and comorbidities were used to identify CABG:PCI ratio related risk for in-hospital CABG and PCI mortality. Higher PCI:CABG ratios correlated with an increased CABG mortality. There was a median (IQR) mortality of 2.5% (1.6-4.3) in the low ratio quartile; 3.1% (1.9-5.3) in the intermediate quartiles; and 5.3% (3.2-9.1) in the high ratio quartile (P < 0.001). On multivariate analysis, the PCI:CABG ratio was associated with an increased risk for CABG mortality with an adjusted odds ratio of 1.38 (95% CI, 1.14-1.67, P < 0.001) and 2.17 (95% CI, 1.70-2.80, P < 0.001) for hospitals with intermediate and high PCI:CABG ratios, respectively. There was no significant association between PCI:CABG ratio and PCI mortality. The programmatic PCI:CABG ratio is a valid indicator of optimal case selection. The PCI:CABG ratio correlates with in-hospital mortality in ACS.

The Asian system for cardiac operative risk evaluation for predicting mortality after isolated coronary artery bypass graft surgery (ASCORE-C).

The mortality of coronary artery bypass graft surgery (CABG) in Asian patients predicted by Western population-based risk models is not ideal. We aimed to develop a risk scoring system based on a multiracial Asian patient population to predict early-stage mortality. A total of 2495 patients who underwent isolated CABG in Singapore from 2009 to 2015 were included to develop a regional scoring system: the regional Asian System for Cardiac Operative Risk Evaluation in CABG (ASCORE-C). Predictors were identified via a stepwise multiple logistic regression to construct models for 30-day, 90-day, and 1-year cumulative mortality prediction. The optimal cut-offs of ASCORE-C risk strata were determined by the multiway χ2 and Interaction Detection decision tree. The performance of ASCORE-C was compared with European System for Cardiac Operative Risk Evaluation score (EuroSCORE) II and Society of Thoracic Surgeons (STS) score by observed/estimated mortality ratio. The observed postoperative 30-day, 90-day, and 1-year cumulative mortality following isolated CABG were 2.6%, 3.3%, and 4.6%, respectively. The ASCORE-C to predict these three events were constructed with age (>65 years), Malay ethnicity, congestive heart failure, abnormal heart rhythm, aortic atherosclerosis, estimated glomerular filtration rate, peripheral vascular disease, critical preoperative status, and emergency surgery. Tested by three different validation datasets, receiver operating characteristic curve of ASCORE-C model prediction performed well with the Hosmer-Lemeshow test. The ASCORE-C was found to have better predictive accuracy than EuroSCORE II and STS score in CABG mortality prediction, especially for the high-risk patients. The ASCORE-C system is reliable for early-stage CABG mortality prediction in a multiracial Asian population.

Trends in In-hospital Coronary Artery Bypass Surgery Mortality by Gender and Race/Ethnicity --1998-2015: Why Do the Differences Remain?

Background and aimsBetween 1998 and 2015, the national coronary artery bypass graft surgery (CABG) in-hospital mortality rate fell nearly 45% to just 2.2% of CABG in-patients. By almost any standards, this large decline in the nation's in-hospital mortality for CABG inpatients has been extraordinary. Yet, over this time period, no studies have detailed these notable trends in in-hospital CABG mortality with an emphasis on the differences by gender and racial/ethnicity. The in-hospital CABG treatment period is the approximately 9 day inpatient length-of-stay the patient is completely under the care of hospital and its staff. Our research seeks to fill this research gap with analyses of 18 years of national data of over 5 million CABG inpatient discharges distinguishing gender by six categories of race/ethnicity (Asian, black, Hispanic, white, other known races/ethnicities, and unknown race/ethnicities) to evaluate three broad questions related to in-hospital CABG mortality: 1) What have been the 18-year national trends in CABG surgeries, length-of-stay, mortality, and type of discharge by gender and race/ethnicity? 2) Over time, what have been the in-hospital mortality trends by gender and race-ethnicity? 3) Using multivariate techniques to control for patient characteristics, risk factors and socioeconomic characteristics of the hospital setting and environment, what is the extent of the variations in in-hospital mortality among the 12 groupings of gender and race-ethnicity? Data and methodsData are from the Nationwide Inpatient Sample (NIS) data from the Healthcare Utilization Project (HCUP–NIS) collected yearly. These data represent 858 hospitals, a 20% national sample representing 5,032,985 CABG patient discharges from hospitals over an 18-year period -- 1998 to 2015. Descriptive and logistic regression analyses are used to evaluate the outcomes. ResultsThe national decline in in-hospital CABG mortality trends over the 18-year period has been dramatic. These declines have substantially impacted all 12 racial/ethnic and gender groupings analyzed during this timeframe. However, over the 18-year period, both univariate and logistic regression results reveal the disadvantages females and black males have in in-hospital CABG mortality rates when compared to the comparison group, white male CABG inpatients. Female CABG inpatients consistently, regardless of their race/ethnicity, have significantly higher in-hospital mortality rates than their corresponding male counterparts even after controlling for patient characteristics and socio-economic status. For males, however, the likelihood of dying in the hospital from a CABG procedure showed wide variation across the four racial/ethnic categories. Compared with white male patients undergoing CABG surgery in the nation's hospitals, after controlling for confounding factors, Hispanic and Asian-American had significantly lower in-hospital CABG mortality rates −9.7% and −17.9% respectively. In contrast, black male CABG patients had a 35.1% higher in-hospital CABG mortality rate than white males. ConclusionsWhile considerable progress has been made reducing overall in-hospital CABG mortality over the past 18-years across all gender and racial/ethnic inpatients, significant gaps persist between black males and other racial/ethnic groups.

The effect of the metabolic syndrome on the risk and outcome of coronary artery bypass graft surgery : cardiovascular topics

The individual components of the metabolic syndrome are risk factors for coronary artery disease. The underlying pathophysiology of a low-grade inflammatory process postulates that the metabolic syndrome could compromise a procedure such as coronary artery bypass graft surgery (CABG) done on cardiopulmonary bypass (CPB). From a single institution, 370 patients with the metabolic syndrome (IDF and ATP III criteria) and 503 patients without the metabolic syndrome were identified. The influence of the metabolic syndrome on the pre-operative core risk factors for CABG mortality as well as its effect on the mortality and major morbidity post surgery were investigated. Patients with the metabolic syndrome were operated on less urgently than those without the metabolic syndrome. The EuroSCORE was also lower in those with the metabolic syndrome. Patients with the metabolic syndrome required fewer units of homologous red blood cells, but stayed statistically longer in hospital. In this surgical population the metabolic syndrome had no detrimental clinical effect on either the pre-operative risk factors or the outcome after CABG.

Certificate of Need (CON) for Cardiac Care: Controversy over the Contributions of CON

To test whether state Certificate of Need (CON) regulations influence procedural mortality or the provision of coronary artery bypass graft surgery (CABG) and percutaneous coronary interventions (PCI). Medicare inpatient claims obtained for 1989-2002 for patients age 65+ who received CABG or PCI. We used differences-in-differences regression analysis to compare states that dropped CON during the sample period with states that kept the regulations. We examined procedural mortality, the number of hospitals in the state performing CABG or PCI, mean hospital volume, and statewide procedure volume for CABG and PCI. States that dropped CON experienced lower CABG mortality rates relative to states that kept CON, although the differential is not permanent. No such mortality difference is found for PCI. Dropping CON is associated with more providers statewide and lower mean hospital volume for both CABG and PCI. However, statewide procedure counts remain the same. We find no evidence that CON regulations are associated with higher quality CABG or PCI. Future research should examine whether the greater number of hospitals performing revascularization after CON removal raises expenditures due to the building of more facilities, or lowers expenditures due to enhanced price competition.

Area socioeconomic status and mortality after coronary artery bypass graft surgery: The role of hospital volume

Individuals of low socioeconomic status (SES) have reduced access to coronary artery bypass graft surgery (CABG). It is unknown if low-SES CABG patients have reduced access to hospitals with better outcomes. We conducted a retrospective cohort analysis of the California CABG Mortality Reporting Program, consisting of individuals with zip code information who underwent CABG at participating hospitals in 1999-2000 (n = 18,961). Primary outcome measures were inhospital mortality after CABG; primary independent variables of interest were area-level SES, clinical risk factors, and hospital volume. We used 2-level hierarchical random-effects logit models to estimate the relationship between explanatory variables and inhospital mortality. Within high-volume hospitals, patients of low-SES areas had greater mortality than those of mid- and high-SES areas (2.5% vs 1.5% vs 1.8%, P = .024). However, there was no relationship between SES and mortality in lower-volume hospitals. Contrary to expectations, individuals of high-SES areas (42%) underwent surgery at low-volume hospitals more often than patients of low-SES areas (28%, P < .001), although mortality at low-volume hospitals was greater than that at high-volume facilities (P < .001). Discrepancies were not explained by distance traveled. Mortality after CABG is modified by both SES and hospital volume. Within high-volume hospitals, patients of low-SES areas fared worse than patients of higher-SES areas. Patients of high SES tended to have CABG surgery at low-volume hospitals where mortality was greater and therefore had higher mortality than expected.

Comparison of Factors Associated With 30-Day Mortality After Coronary Artery Bypass Grafting in Patients With Versus Without Diabetes Mellitus

The purpose of this study was to identify factors associated with 30-day mortality after coronary artery bypass graft surgery (CABG) among diabetic patients, and to compare them with risk factors among nondiabetics. A subanalysis of a prospective national cohort study was performed which included patients who underwent CABG in 14 medical centers in Israel during 1994. Data including patient demographic and historical information, comorbidity, and cardiac catheterization results were collected by trained nurses. Data were derived from direct patient interviews, charts, catheterization reports, surgical reports, and national vital records. Multivariate logistic regression analysis was used to identify factors associated with a 30-day mortality in diabetic and nondiabetic patient populations. The results showed that crude mortality was 5.0% among diabetic patients (n = 1,034) and 2.5% among nondiabetics (n = 3,350; p <0.001). The risk profile in diabetics was found to be worse. Multivariate logistic regression analysis identified female gender, 3-vessel disease, and left main disease as independent risk factors for 30-day, post-CABG mortality unique to diabetic patients. Left ventricular dysfunction was found to effect a greater risk among diabetic patients, whereas chronic renal failure was associated with greater risk among nondiabetics. In conclusion, we found differences in patterns of risk factors for post-CABG mortality between diabetics and nondiabetics. These findings may help physicians to identify patients at high risk for CABG mortality.