Risk scores do not predict high mortality after coronary artery bypass surgery in the presence of diastolic dysfunction
Risk scores do not predict high mortality after coronary artery bypass surgery in the presence of diastolic dysfunction
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DOI：
10.1016/j.athoracsur.2007.12.068
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发表时间：
2008-04-01
影响因子：
4.6
通讯作者：
Westerberg, Bernhard
中科院分区：
文献类型：
--
作者：
Merello, Lorenzo;Riesle, Erick;Westerberg, Bernhard
背景。尽管体外循环冠状动脉旁路移植术后的全球术后死亡率约为 3%，但在某些群体中，死亡率可能要高得多。已知许多疾病会增加死亡率，并已被纳入众所周知的评分系统中；然而，左心室舒张功能障碍尚未得到充分评估，以确定其对冠状动脉旁路移植术后死亡率的预测价值，也未将其纳入当前使用的风险评分中。对 191 名计划进行体外循环冠状动脉旁路移植术的患者的左心室充盈模式进行了前瞻性评估。术后30天随访生存情况和并发症。将观察到的死亡率与 EuroSCORE 和 Parsonnet 评分预测的死亡率进行比较。结果。研究发现舒张功能、合并症的存在和术后生存率之间存在相关性。充盈模式正常组（33 名患者中的 0 名）没有死亡。在放松改变的情况下，129 名患者中有 5 名死亡（3.8%）；在假正常组中，16 名患者中有 2 名（12.5%）；在限制组中，13 名患者中有 6 名（46.1%；p < 0.01）。 Parsonnet 和 EuroSCORE 预测每组的死亡率分别为 1.5% 至 1.6%、1.5% 至 2.0%、1.5% 至 2.2% 和 3.9% 至 4.1%。 E 减速时间为 150 ms 或更长的组的死亡率为 2.8%，E 减速时间小于 150 ms 的组的死亡率为 17.3% (p < 0.01)。晚期功能障碍组的术后并发症也更常见。结论。严重的舒张功能障碍是体外循环冠状动脉旁路移植术后不良结果和死亡率的有力预测因素，而 EuroSCORE 和 Parsonnet 评分并不能充分预测这种高风险。舒张功能的测量应包含在常规术前风险评估中。
Background. Although global postoperative mortality after on-pump coronary artery bypass grafting is approximately 3%, in some groups it can be considerably higher. Many conditions are known to increase mortality and have been included in well-known scoring systems; however, left ventricular diastolic dysfunction has not been sufficiently evaluated to identify its predictive value for mortality after coronary artery bypass grafting, nor is it integrated in currently used risk scores.Methods. Left ventricular filling pattern was prospectively evaluated in 191 patients scheduled for on-pump coronary artery bypass grafting. A follow-up of survival and complications was made for 30 days postoperatively. Observed mortality was compared with the mortality predicted by the scores of EuroSCORE and Parsonnet.Results. A correlation was found between diastolic function, the presence of comorbidities, and postoperative survival. There was no mortality in the group with normal filling pattern (0 of 33 patients). In the presence of an alteration of relaxation, mortality was 5 of 129 patients (3.8%); in the pseudonormal group it was 2 of 16 patients (12.5%); and in the restrictive group it was 6 of 13 patients (46.1%; p < 0.01). Parsonnet and EuroSCORE predicted a mortality of 1.5% to 1.6%, 1.5% to 2.0%, 1.5% to 2.2%, and 3.9% to 4.1% for each group, respectively. Mortality in the group with E deceleration time of 150 ms or greater was 2.8% and in the group with E deceleration time less than 150 ms was 17.3% (p < 0.01). Postoperative complications were also more frequent in the group with advanced dysfunction.Conclusions. Severe diastolic dysfunction is a strong predictor of adverse outcome and mortality after on-pump coronary artery bypass grafting, and this high risk is not adequately predicted by EuroSCORE and Parsonnet score. Measures of diastolic function should be included in routine preoperative risk assessment.