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- Rexius, Helena, 1967, et al.
(författare)
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A simple score to assess mortality risk in patients waiting for coronary artery bypass grafting
- 2006
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Ingår i: Ann Thorac Surg. - : Elsevier BV. - 1552-6259 .- 0003-4975. ; 81:2, s. 577-82
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Independent risk factors for death in patients waiting for elective coronary artery bypass surgery have previously been identified. A prioritization where these factors are considered may potentially reduce waiting list mortality. A simple score based on the risk factors was constructed and validated. METHODS: A scoring system based on risk factors in 5,864 consecutive patients operated from 1995 to 1999 was constructed. The following factors were included in the score: unstable angina (3 points [p]), left main stenosis (2p), concomitant aortic valve disease (2p), operative risk (0-2p), left ventricular ejection fraction (0-2p), and male gender (1p). The score was retrospectively validated in 5,167 new patients operated from 1999 to 2003. Based on the sum of risk score points, the patients were divided into three risk groups: low risk (0-2p), intermediate risk (3-5p) and high risk (> or = 6p). The risk groups were related to waiting list mortality and clinical priority (imperative, urgent, and routine). RESULTS: Median waiting time was 33 days. Forty-two patients (0.8%) died while waiting for surgery (5.2 deaths/100 waiting years). Of the patients, 2,406 (47%) were low risk, 1,990 (38%) intermediate risk, and 771 (15%) high risk. Mortality incidence in the high-risk group was fivefold higher than in the intermediate group and 25-fold higher than in the low-risk group (32, 7, and 1.3 deaths/100 waiting years, respectively, p < 0.001 between all groups). Twenty-three percent of the patients in the high-risk group had not been given imperative clinical priority. CONCLUSIONS: The score system identifies patients with increased risk of death while waiting for coronary artery bypass grafting. The score may be used to facilitate and improve the prioritization process.
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| 2. |
- Rexius, Helena, 1967, et al.
(författare)
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Gender and mortality risk on the waiting list for coronary artery bypass grafting
- 2004
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Ingår i: Eur J Cardiothorac Surg. - : Oxford University Press (OUP). - 1010-7940. ; 26:3, s. 521-7
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: There are gender differences in clinical presentation, treatment and outcome of patients with coronary artery disease. We investigated whether there is also a gender difference in terms of mortality risk on the waiting list in patients accepted for coronary artery bypass grafting (CABG). METHODS: All our patients accepted for elective CABG 1995-1999 (1303 women and 4561 men) were included. Prospectively registered preoperative characteristics and mortality were compared between men and women. Hazard functions for death on the waiting list were calculated using Poisson regression. RESULTS: At acceptance, women were older (68+/-9 vs 65+/-9 years, P<0.001), had a higher Cleveland risk score (2.4+/-1.8 vs 1.8+/-1.8, P<0.001) and a better left ventricular ejection fraction (60+/-14 vs 57+/-14%, P<0.001). More women had unstable angina pectoris (33 vs 20%, P<0.001), diabetes mellitus (23 vs 17%, P<0.001), chronic obstructive pulmonary disease (8 vs 5%, P<0.001), hypertension (47 vs 37%, P<0.001) and planned concomitant aortic valve surgery (13 vs 4%, P<0.001) while more men had three vessel disease (70 vs 66%, P=0.001). Median waiting time (55 vs 54 days, P=0.19) and unadjusted mortality (1.4 vs 1.0%, P=0.25) on the waiting list did not differ significantly between men and women but in a multivariate hazard analysis, female gender was associated with a lower risk than men of death on the waiting list (risk ratio 0.42, 95% confidence interval 0.19-0.93, P=0.032). CONCLUSIONS: Women have a lower risk of death on the waiting list for CABG, in spite of more advanced age, more co-morbidity, and a higher percentage of unstable angina pectoris.
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| 3. |
- Rexius, Helena, 1967, et al.
(författare)
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Mortality on the waiting list for coronary artery bypass grafting: incidence and risk factors
- 2004
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Ingår i: Ann Thorac Surg. - 0003-4975. ; 77:3
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Insufficient capacity for coronary artery bypass grafting results in waiting times before operation, prioritization of patients and, ultimately, death on the waiting list. We aimed to calculate waiting list mortality and to identify risk factors for death on the waiting list. METHODS: The study included 5,864 consecutive patients accepted for elective coronary artery bypass grafting (78% male; mean age, 66 +/- 9 years). The patients were categorized at acceptance into three priority groups: imperative (39%), urgent (36%), or routine (25%). Waiting list mortality was calculated and compared between groups, and risk factors were identified by Poisson regression. RESULTS: Median waiting time for the whole population was 55 days. Seventy-seven patients (1.3%) died, corresponding to a mortality rate of 5.8 deaths per 100 patient-years. The mortality rate per 100 patient-years was highest for those in the imperative group, 15.1 deaths, compared with 5.3 deaths in the urgent group and 3.2 in the routine group (p < 0.001). Independent risk factors were male sex (p = 0.032), Cleveland Clinic risk score (p = 0.005), impaired left ventricular ejection fraction (p = 0.007), unstable angina pectoris (p = 0.001), concomitant aortic valve disease (p = 0.002), priority group (p < 0.001), and time after acceptance (p = 0.019). The mortality risk increased with time after acceptance by 11% a month. CONCLUSIONS: Long waiting lists for coronary artery bypass grafting are associated with considerable mortality. The risk of death increases significantly with waiting time. Sex, unstable angina, perioperative risk, impaired left ventricular function, and concomitant aortic valve disease are independent risk factors and should be considered at triage.
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| 4. |
- Rexius, Helena, 1967, et al.
(författare)
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Waiting time and mortality after elective coronary artery bypass grafting
- 2005
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Ingår i: Ann Thorac Surg. - 1552-6259. ; 79:2, s. 538-43
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Limited resources for coronary artery bypass grafting (CABG) results in waiting times, prioritization between patients, and to mortality among the patients on the waiting list. Waiting time is an independent predictor for mortality on the waiting list, but it is not clear if the waiting time also influences outcome after CABG. METHODS: The study population was 5453 consecutive CABG patients who were prioritized at acceptance into three groups: imperative (CABG intended within 2 weeks), urgent (within 12 weeks), and routine (within 6 months). Postoperative mortality was compared between patients operated on within or after the intended waiting time in their respective groups. A multivariate Poisson regression model was used to further determine the effect of waiting time on postoperative mortality. Mean follow up was 24 +/- 15 months. RESULTS: Median waiting time was 55 days. Fifty-five percent of the patients were operated on within the intended waiting time. Postoperative mortality during follow-up was higher in patients operated on after the intended time (8.0 vs 6.2%, p = 0.014), but after correction for age, gender, operative risk, and angina symptoms, waiting time was not an independent predictor for postoperative death (risk ratio, 0.98 per waiting month; 95% confidence interval, 0.97 to 1.00; p = 0.44). CONCLUSIONS: The results suggest that mortality after CABG is not influenced by prolonged waiting time. The result does not exclude subgroups of patients that might benefit from a shorter waiting time.
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