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- Andell, Pontus, et al.
(författare)
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Outcome of patients with chronic obstructive pulmonary disease and severe coronary artery disease who had a coronary artery bypass graft or a percutaneous coronary intervention
- 2017
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Ingår i: European Journal of Cardio-Thoracic Surgery. - : Oxford University Press (OUP). - 1010-7940 .- 1873-734X. ; 52:5, s. 930-936
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Patients with chronic obstructive pulmonary disease (COPD) who also have acute coronary syndromes are a high-risk population with a high mortality rate. Little is known about these patients following coronary artery bypass grafting (CABG). METHODS: Patients presenting with acute coronary syndromes between 2006 and 2014 with an angiogram showing 3-vessel disease or left main coronary artery involvement who were treated with CABG or percutaneous coronary intervention (PCI) only were included from the nationwide SWEDEHEART registry. Patients were stratified according to COPD status and compared with regard to outcome. The primary end-point was the 5-year mortality rate; secondary outcomes were the 30-day mortality rate and in-hospital complications after CABG. RESULTS: We identified 6985 patients in the population who had CABG (COPD prevalence = 8.0%) and 14 209 who had PCI only (COPD = 8.2%). Patients with COPD were older and had more comorbidities than patients without COPD. The 5-year mortality rate was nearly doubled in patients with COPD versus patients without COPD (CABG: 27.2% vs 14.5%, P < 0.001; PCI only: 50.1% vs 29.1%, P < 0.001). After adjusting for age, sex and comorbidities, patients with COPD in both CABG-treated [hazard ratio = 1.52 (1.25-1.86), P < 0.001] and PCI-treated populations still had a significantly higher 5-year mortality rate. COPD was also independently associated with significantly more postoperative infections in need of antibiotics [odds ratio = 1.48 (1.07-2.04), P = 0.017] and pneumonia [odds ratio = 2.21 (1.39-3.52), P = 0.001]. CONCLUSIONS: Patients with COPD presenting with acute coronary syndromes and severe coronary artery disease are a high-risk population following CABG or PCI only, with higher risk of long-term and short-term death and postoperative infections. Preventive measures, including careful monitoring for signs of infection and prompt antibiotic treatment when indicated, should be considered.
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| 2. |
- Nozohoor, Shahab, et al.
(författare)
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Validation of a modified EuroSCORE risk stratification model for cardiac surgery: the Swedish experience.
- 2011
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Ingår i: European Journal of Cardio-Thoracic Surgery. - : Oxford University Press (OUP). - 1010-7940. ; 40:1, s. 185-191
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The European System for Cardiac Operative Risk Evaluation (EuroSCORE) is used to identify patients at high risk for aortic valve replacement (AVR) in whom alternative procedures, such as trans-catheter aortic valve implantation (TAVI), may be appropriate. The aim of the present study was to calibrate and validate the EuroSCORE for different cardiac surgery procedures to improve patient selection for valve surgery. Methods: The study included 46516 patients undergoing open cardiac surgery during 2001-2007. A fivefold cross-validation technique was used to calibrate four different models. Model discrimination was determined by the area under the receiver operating characteristic (ROC) curve and model calibration by the Hosmer-Lemeshow (H-L) test. Results: The actual and predicted 30-day mortality was 3.2%. The discrimination (ROC area) of the calibrated 30-day mortality prediction models was 0.79 for coronary bypass surgery, 0.77 for mitral valve surgery (MVS), and 0.75 for miscellaneous procedures, compared with 0.78 (p=0.199), 0.74 (p=0.077), and 0.72 (p=0.001), respectively, for the original EuroSCORE. The discrimination for AVR was the same for the calibrated and the original EuroSCORE model (0.70). The H-L test gave a p-value of 0.104 for the calibrated and <0.001 for the original EuroSCORE model. Conclusions: A calibration of EuroSCORE resulted in an acceptable predictive capacity for 30-day mortality, and improved discrimination and calibration for MVS and miscellaneous procedures. However, the poor discriminatory for the AVR procedure suggests that the EuroSCORE may not be satisfying for assessing risk prior to TAVI and that more optimized risk stratification models may be needed.
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