Key result
Adding diastolic dysfunction, heart rate, and LA size to STS score improves post-CABG risk prediction to ~0.82 AUC.
Why the study?
The accuracy of predicting early postoperative complications after elective CABG using the STS score alone is limited and may be improved by adding LVDD, HR, and LA size indicators.
Does adding left ventricular diastolic dysfunction, heart rate, and left atrial size to the STS score improve the prediction of early postoperative complications in patients undergoing elective CABG?
Cohort (n=178)
No
Does adding left ventricular diastolic dysfunction, heart rate, and left atrial size to the STS score improve the prediction of early postoperative complications in patients undergoing elective CABG?
Answers are grounded in this paper and cite their sources.
Adding preoperative echocardiographic markers of diastolic dysfunction and chronic remodeling to the STS score significantly improves the prediction of early postoperative complications after elective CABG.
Objective: To improve the accuracy of predicting early postoperative complications in patients with coronary artery disease (CAD) who underwent elective coronary artery bypass grafting (CABG) by supplementing the STS Score with indicators of left ventricular diastolic dysfunction (LVDD), heart rate (HR), and left atrial (LA) size.Methods: This single-center observational cohort analysis included 178 consecutive adult patients with CAD who underwent elective CABG.Preoperative clinical, laboratory, electrocardiographic, echocardiographic, and functional parameters were analyzed.Depending on the early postoperative course during the index hospitalization, patients were stratified into a favorable-course group (n=136) and a postoperative-complications group (n=42).The primary outcome was a composite of early postoperative complications, including cardiac, respiratory, renal, neurological, infectious, and bleeding-related events requiring additional treatment or prolonging intensive care or hospital stay.LVDD was diagnosed by a multiparametric Doppler echocardiographic approach according to contemporary recommendations, including mitral inflow parameters, tissue Doppler e′ velocity, average E/e′ ratio, tricuspid regurgitation velocity, and LA size/volume where available.Logistic regression and ROC analysis were used to identify predictors of complications; ROC curves were compared using the DeLong method.Results: LVDD was identified as an independent and clinically significant predictor of early postoperative complications after CABG.The STS score demonstrated moderate discriminative ability (AUC 0.72; 95% CI 0.64-0.80).The addition of LVDD to the STS score model significantly improved predictive performance (AUC 0.75; 95% CI 0.68-0.83;ΔAUC=+0.03;p=0.041).The inclusion of HR and LA size resulted in further significant improvement (AUC 0.82; 95% CI 0.75-0.88;ΔAUC=+0.10;p<0.001).Conclusion: LVDD reflects reduced diastolic reserve and increased vulnerability to perioperative hemodynamic stress, which are not fully captured by traditional risk scores.Adding LVDD to the STS score provides a statistically significant improvement in predicting early postoperative complications after CABG.The highest prognostic accuracy is achieved using a combined model that includes STS score, LVDD, HR, and LA size.
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Nazarov et al. (2026) conducted a cohort in Coronary artery disease (CAD) (n=178). Combined model (STS score + LVDD + Heart Rate + LA size) vs. STS score alone was evaluated on Predicting a composite of early postoperative complications (AUC) (ΔAUC +0.10, 95% CI 0.75-0.88, p=<0.001). Adding left ventricular diastolic dysfunction, heart rate, and left atrial size to the standard STS score significantly improved the prediction of early postoperative complications after elective CABG, increasing the AUC from 0.72 to 0.82.
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