Coronary artery bypass surgery prognosis
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Coronary Artery Bypass Surgery Microchapters | |
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Coronary artery bypass surgery prognosis On the Web | |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-in-Chief: Cafer Zorkun, M.D., Ph.D. [2], Mohammed A. Sbeih, M.D. [3] Anahita Deylamsalehi, M.D.[4]
Overview
Prognosis following Coronary artery bypass surgery (CABG) depends on a variety of factors. In general, CABG improves the chances of survival of patients who are at high risks, such as those patients with the left main disease. After approximately 5 years the difference in survival rate between those who have had surgery and those treated by medication therapy diminishes. Age at the time of CABG is critical to the prognosis, therefore younger patients with no complicating diseases have a high probability of greater longevity. Recommended by ACC 2021 guideline, STS score system can be used to predict adverse outcomes of CABG such as death, renal failure, prolonged hospital stay, and mediastinitis.
Prognosis
Age
- Age at the time of CABG is critical factor to determine the prognosis. Younger patients with no complicating diseases have a high probability of greater longevity.
- In a cohort study of 1,388 patients who were 48.9 years in average at the time of their first surgery survival rate were as follows:
- 5 years: 93.6%
- 10 years: 81.1%
- 15 years: 62.1%
- 20 years: 46.7%
- 23 years: 38.4%
Society of Thoracic Surgery (STS) Risk Score
- Based on ACC 2021 revascularization guideline, STS risk score is recommended to predict the prognosis of CABG.[1]
- This score system can predict the adverse outcomes of CABG such as death, permanent stroke, renal failure, repeated surgery, deep sternal wound infection, prolonged mechanical ventilation, and hospitalization.[1]
- Compared to EuroSCORE II (the European System for Cardiac Operative Risk Evaluation), STS risk score is more accurate in predicting CABG outcomes, especially at mortality rates higher than 5%.[1]
- STS risk score is limited in evaluating the effect of conditions such as cirrhosis, malnutrition, and frailty on CABG's outcome. Therefore, for patients who are candidates for CABG and have those conditions other tools should be used.
- STS risk score is derived from the United States' data on patients who had CABG.[1] The following table shows last updated STS risk score (2018) for patients who had only CABG or CABG with a heart value surgery.[2]
| Adverse Outcomes | CABG | CABG and heart value surgery |
|---|---|---|
| Mortality rate | 0.804 | 0.761 |
| Permanent stroke | 0.697 | 0.632 |
| Renal failure | 0.826 | 0.759 |
| Prolonged mechanical ventilation | 0.772 | 0.744 |
| Repeated surgery | 0.621 | 0.588 |
| Composite morbidity and mortality | 0.738 | 0.712 |
| Prolonged post operation hospitalization | 0.777 | 0.739 |
| Deep sternal wound infection/Mediastinitis | 0.681 | 0.659 |
2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)[3]
Public Reporting of Cardiac Surgery Outcomes (DO NOT EDIT)[3]
| Class I |
| "1. Public reporting of cardiac surgery outcomes should use risk-adjusted results based on clinical data.[4][5][6][7][8][9][10][11] (Level of Evidence: B)" |
Use of Outcomes or Volume as CABG Quality Measures (DO NOT EDIT)[3]
| Class I |
| "1. All cardiac surgery programs should participate in a state, regional, or national clinical data registry and should receive periodic reports of their risk-adjusted outcomes. (Level of Evidence: C)" |
| Class IIa |
| "1. When credible risk-adjusted outcomes data are not available, volume can be useful as a structural metric of CABG quality.[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] (Level of Evidence: B)" |
| Class IIb |
| "1. Affiliation with a high-volume tertiary center might be considered by cardiac surgery programs that perform fewer than 125 CABG procedures annually. (Level of Evidence: C)" |
References
- ↑ 1.0 1.1 1.2 1.3 Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM; et al. (2022). "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". J Am Coll Cardiol. 79 (2): e21–e129. doi:10.1016/j.jacc.2021.09.006. PMID 34895950 Check
|pmid=value (help). - ↑ O'Brien SM, Feng L, He X, Xian Y, Jacobs JP, Badhwar V; et al. (2018). "The Society of Thoracic Surgeons 2018 Adult Cardiac Surgery Risk Models: Part 2-Statistical Methods and Results". Ann Thorac Surg. 105 (5): 1419–1428. doi:10.1016/j.athoracsur.2018.03.003. PMID 29577924.
- ↑ 3.0 3.1 3.2 Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG; et al. (2011). "2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0b013e31823c074e. PMID 22064599.
- ↑ Geraci JM, Johnson ML, Gordon HS, Petersen NJ, Shroyer AL, Grover FL; et al. (2005). "Mortality after cardiac bypass surgery: prediction from administrative versus clinical data". Med Care. 43 (2): 149–58. PMID 15655428.
- ↑ Hannan EL, Kilburn H, Lindsey ML, Lewis R (1992). "Clinical versus administrative data bases for CABG surgery. Does it matter?". Med Care. 30 (10): 892–907. PMID 1405795.
- ↑ Hannan EL, Racz MJ, Jollis JG, Peterson ED (1997). "Using Medicare claims data to assess provider quality for CABG surgery: does it work well enough?". Health Serv Res. 31 (6): 659–78. PMC 1070152. PMID 9018210.
- ↑ Hartz AJ, Kuhn EM (1994). "Comparing hospitals that perform coronary artery bypass surgery: the effect of outcome measures and data sources". Am J Public Health. 84 (10): 1609–14. PMC 1615096. PMID 7943479.
- ↑ Jones RH, Hannan EL, Hammermeister KE, Delong ER, O'Connor GT, Luepker RV; et al. (1996). "Identification of preoperative variables needed for risk adjustment of short-term mortality after coronary artery bypass graft surgery. The Working Group Panel on the Cooperative CABG Database Project". J Am Coll Cardiol. 28 (6): 1478–87. PMID 8917261.
- ↑ Mack MJ, Herbert M, Prince S, Dewey TM, Magee MJ, Edgerton JR (2005). "Does reporting of coronary artery bypass grafting from administrative databases accurately reflect actual clinical outcomes?". J Thorac Cardiovasc Surg. 129 (6): 1309–17. doi:10.1016/j.jtcvs.2004.10.036. PMID 15942571.
- ↑ Shahian DM, Silverstein T, Lovett AF, Wolf RE, Normand SL (2007). "Comparison of clinical and administrative data sources for hospital coronary artery bypass graft surgery report cards". Circulation. 115 (12): 1518–27. doi:10.1161/CIRCULATIONAHA.106.633008. PMID 17353447.
- ↑ Tu JV, Sykora K, Naylor CD (1997). "Assessing the outcomes of coronary artery bypass graft surgery: how many risk factors are enough? Steering Committee of the Cardiac Care Network of Ontario". J Am Coll Cardiol. 30 (5): 1317–23. PMID 9350934.
- ↑ Clark RE (1996). "Outcome as a function of annual coronary artery bypass graft volume. The Ad Hoc Committee on Cardiac Surgery Credentialing of The Society of Thoracic Surgeons". Ann Thorac Surg. 61 (1): 21–6. PMID 8561556.
- ↑ Grumbach K, Anderson GM, Luft HS, Roos LL, Brook R (1995). "Regionalization of cardiac surgery in the United States and Canada. Geographic access, choice, and outcomes". JAMA. 274 (16): 1282–8. PMID 7563533.
- ↑ Hannan EL, Kilburn H, Bernard H, O'Donnell JF, Lukacik G, Shields EP (1991). "Coronary artery bypass surgery: the relationship between inhospital mortality rate and surgical volume after controlling for clinical risk factors". Med Care. 29 (11): 1094–107. PMID 1943270.
- ↑ Hannan EL, Siu AL, Kumar D, Kilburn H, Chassin MR (1995). "The decline in coronary artery bypass graft surgery mortality in New York State. The role of surgeon volume". JAMA. 273 (3): 209–13. PMID 7807659.
- ↑ Hannan EL, Wu C, Ryan TJ, Bennett E, Culliford AT, Gold JP; et al. (2003). "Do hospitals and surgeons with higher coronary artery bypass graft surgery volumes still have lower risk-adjusted mortality rates?". Circulation. 108 (7): 795–801. doi:10.1161/01.CIR.0000084551.52010.3B. PMID 12885743.
- ↑ Kalant N, Shrier I (2004). "Volume and outcome of coronary artery bypass graft surgery: are more and less the same?". Can J Cardiol. 20 (1): 81–6. PMID 14968146.
- ↑ Nallamothu BK, Saint S, Ramsey SD, Hofer TP, Vijan S, Eagle KA (2001). "The role of hospital volume in coronary artery bypass grafting: is more always better?". J Am Coll Cardiol. 38 (7): 1923–30. PMID 11738295.
- ↑ Peterson ED, Coombs LP, DeLong ER, Haan CK, Ferguson TB (2004). "Procedural volume as a marker of quality for CABG surgery". JAMA. 291 (2): 195–201. doi:10.1001/jama.291.2.195. PMID 14722145.
- ↑ Rathore SS, Epstein AJ, Volpp KG, Krumholz HM (2004). "Hospital coronary artery bypass graft surgery volume and patient mortality, 1998-2000". Ann Surg. 239 (1): 110–7. doi:10.1097/01.sla.0000103066.22732.b8. PMC 1356200. PMID 14685108.
- ↑ Shahian DM, O'Brien SM, Normand SL, Peterson ED, Edwards FH (2010). "Association of hospital coronary artery bypass volume with processes of care, mortality, morbidity, and the Society of Thoracic Surgeons composite quality score". J Thorac Cardiovasc Surg. 139 (2): 273–82. doi:10.1016/j.jtcvs.2009.09.007. PMID 20022608.
- ↑ Showstack JA, Rosenfeld KE, Garnick DW, Luft HS, Schaffarzick RW, Fowles J (1987). "Association of volume with outcome of coronary artery bypass graft surgery. Scheduled vs nonscheduled operations". JAMA. 257 (6): 785–9. PMID 3492614.
- ↑ Shroyer AL, Marshall G, Warner BA, Johnson RR, Guo W, Grover FL; et al. (1996). "No continuous relationship between Veterans Affairs hospital coronary artery bypass grafting surgical volume and operative mortality". Ann Thorac Surg. 61 (1): 17–20. doi:10.1016/0003-4975(95)00830-6. PMID 8561546.
- ↑ Sowden AJ, Deeks JJ, Sheldon TA (1995). "Volume and outcome in coronary artery bypass graft surgery: true association or artefact?". BMJ. 311 (6998): 151–5. PMC 2550219. PMID 7613425.
- ↑ Welke KF, Barnett MJ, Sarrazin MS, Rosenthal GE (2005). "Limitations of hospital volume as a measure of quality of care for coronary artery bypass graft surgery". Ann Thorac Surg. 80 (6): 2114–9. doi:10.1016/j.athoracsur.2005.05.017. PMID 16305854.
- ↑ Wu C, Hannan EL, Ryan TJ, Bennett E, Culliford AT, Gold JP; et al. (2004). "Is the impact of hospital and surgeon volumes on the in-hospital mortality rate for coronary artery bypass graft surgery limited to patients at high risk?". Circulation. 110 (7): 784–9. doi:10.1161/01.CIR.0000138744.13516.B5. PMID 15302792.