Key result
Despite a significant increase in predicted operative risk over time, 30-day mortality after CABG was 1.6% in 2003-2006 compared to 2.5% in 1993-1997 (P=0.49).
Why the study?
How has the operative risk and 30-day mortality of patients undergoing CABG changed over time from 1993 to 2006?
Observational (n=1,349)
No
How has the operative risk and 30-day mortality of patients undergoing CABG changed over time from 1993 to 2006?
Absolute Event Rate: 1.6% vs 2.5%
p-value: p=0.49
Despite an increasing burden of comorbidities and operative risk over time, 30-day mortality after CABG has decreased, suggesting improvements in perioperative care and operative strategy.
Stable CABG mortality despite rising risk may reflect care gains; leaves open confirmation in larger prospective studies.
The aim of the present study was to evaluate the changing risk of patients undergoing coronary artery bypass grafting (CABG). Residents of Oulu who underwent coronary angiography and/or revascularization from 1993 to 2006 formed the basis of this community-wide study. One thousand three hundred and forty-nine consecutive patients who underwent CABG have been included in the analysis on changing operative risk and results after CABG. A significant increase in the operative risk occurred in patients who underwent CABG (mean logistic EuroSCORE in 1278 patients: 1993-1997: 3.7%; 1998-2002: 4.6%; 2003-2006: 5.4%; P<0.0001). Thirty-day mortality decreased during the last period (1993-1997: 2.5%; 1998-2002: 3.0%; 2003-2006: 1.6%; P=0.49). The area under the ROC curve of logistic EuroSCORE (1993-1997: 0.86; 1998-2002: 0.78; 2003-2006: 0.99) for prediction of 30-day postoperative mortality markedly improved during the last study period. Despite the increased operative risk, off-pump coronary surgery was associated with lower immediate postoperative mortality rates. Contrary to on-pump surgery, immediate postoperative death occurred after off-pump surgery only in patients with additive EuroSCORE >or=6. The results of this study suggest that improved perioperative care as well as changes in operative strategy are positively faced with the increased burden of comorbidities and operative risk of patients currently undergoing CABG.
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Biancari et al. (2008) conducted an observational in Coronary artery disease requiring CABG (n=1,349). CABG in later time period (2003-2006) vs. CABG in earlier time period (1993-1997) was evaluated on 30-day mortality (p=0.49). Despite a significant increase in predicted operative risk over time, 30-day mortality after CABG was 1.6% in 2003-2006 compared to 2.5% in 1993-1997 (P=0.49).
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