Associated Factors and Simple Preoperative Risk Score for In-hospital Mortality Following Coronary Artery Bypass Graft

Suwimonthip  Thienpratharn; Waranya  Sermkasemsin; Damri  Srethajinda; Thidarat  Ariyanuchitkul

Authors

Suwimonthip Thienpratharn Department of Anesthesiology, Maharat Nakhonratchasima Hospital, Nakhonratchasima 30000, Thailand
Waranya Sermkasemsin Department of Anesthesiology, Maharat Nakhonratchasima Hospital, Nakhonratchasima 30000, Thailand
Damri Srethajinda Department of Anesthesiology, Maharat Nakhonratchasima Hospital, Nakhonratchasima 30000, Thailand
Thidarat Ariyanuchitkul Department of Anesthesiology, Maharat Nakhonratchasima Hospital, Nakhonratchasima 30000, Thailand

Keywords:

coronary artery bypass graft, in-hospital mortality, myocardial infarction, risk factor

Abstract

Introduction: Myocardial infarction is the most common cause of acute sudden death worldwide. The standard treatment is coronary artery bypass graft (CABG), with an overall in-hospital mortality rate of 2.5% to 12.5%. The objective of the study is to describe the associated factors and simple preoperative risk score for in-hospital mortality following CABG. Methods: A retrospective case-control study was conducted between January 1, 2016, and December 31, 2021. Medical records were collected. Multivariable logistic regression was used to explore for potential risk factors. The selected logistic coefficients were transformed into risk-based scoring system. Results: A total of 255 cases were included in analysis and predictive model development, 51 in in-hospital mortality group and 204 in survivals group. The factors associated with mortality included age >80 years, combined aortic surgery, ACC time >120 min, preoperative albumin <3.5 g/dL, and IMA graft. Preoperative factors including age, CHF, aortic disease and serum albumin were used to develop the score-based model with showing AuROC of 0.75 (95% CI 0.67-0.83). The scoring system ranged from 0 to 8.5 was classified into 3 subcategories. The likelihood ratio of positive for in-hospital mortality was 0.17 (95% CI 0.02-0.68) in the low risk, 1.02 (95% CI 0.77-1.34) in the moderate risk, and 4.61 (95% CI 1.94-10.92) in the high-risk category. Conclusion: A simple risk scoring system may help care providers become aware of in-hospital mortality. Patients in the high-risk category should be informed about their risk and deserve closed observation and monitoring. The consideration of IMA graft utilization and minimizing ACC time may help to diminish mortality rates.

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