Establishment Of Anatomic-Clinical Risk Score System For Coronary Artery Bypass Grafting

Objective: The aim of this study was to evaluate the effect of coronary artery anatomical score on early postoperative mortality in CABG patients,and to establish an anatomic-clinical risk score system for coronary artery bypass grafting.Methods: The clinical data of patients who were performed with a CABG surgery alone in the Department of Cardiovascular Surgery,Tianjin Chest Hospital from July 2017 to December 2018 were collected.The clinical data included general conditions,relevant medical history,laboratory examination indexes,coronary angiography,and clinical ultrasound examination results,surgical related conditions.The clinical end point was all-cause death within 30 days after surgery.Univariate analysis,univariate logistic analysis and multivariate logistic regression analysis were performed on the clinical data of the patients to obtain the risk factors affecting the early postoperative death of CABG in our center,to evaluate the influence of coronary artery anatomical score on the early postoperative death of CABG,and to establish the anatomic-clinical risk score system for coronary artery bypass grafting.Results: A total of 1301 patients received CABG alone were included in this study,including 1281 patients in the early postoperative survival group and 20 patients in the death group.?.Results of univariate analysis: 1.General situation Age: the age of patients in the death group was higher than that in the survival group(69.80±7.85 vs 62.94±8.28,P<0.001).2.Critical condition Critical condition of patients in the death group were significantly higher than those in the survival group(40% vs 4.6%,P<0.001).3.Laboratory examination indexes results:(1)Preoperative last creatinine level: the preoperative creatinine level in the death group was significantly higher than that in the survival group(101.55±43.05 vs 76.88±18.25,P<0.001).(2)Preoperative last albumin level: the preoperative albumin level in the death group was significantly lower than that in the survival group(38.36±5.07 vs 41.50±3.98,P<0.001).(3)Preoperative last NT-proBNP level: the preoperative NT-proBNP level in the death group was significantly higher than that in the survival group(lgNT-proBNP,2.70±0.72 vs 2.33±0.52,P=0.001).4.Heart-related risk factors NYHA classification: more NYHA ? or ? classification in dead group than that in survival group(21.1% vs 55%,P=0.001).5.Surgical related factors Use of internal mammary artery bridge: the use of internal mammary artery bridge in the death group was lower than that in the survival group(60% vs 83.3%,P=0.012).6.Anatomical risk factors SYNTAX score: SYNTAX score was significantly higher in the death group than in the survival group [37.73(30.50-45.38)vs 33.13(26-40),P=0.032].?.Results of univariate logistic regression analysis Age 75 or higher,critical condition,creatinine clearance <85 ml/min,preoperative last albumin levels <35 g/L,NYHA ? or ?,SYNTAX score ?29 points has statistical differences in survival group and death group.?.Results of multivariate logistic regression analysis Age 75 or higher,history of diabetes,critical condition,creatinine clearance <85 ml/min,preoperative last albumin levels <35 g/L,NYHA ? or ?,SYNTAX score ?29 points were independent risk factors of early postoperative death.Conclusions: 1.Age 75 or higher,history of diabetes,critical condition,creatinine clearance <85 ml/min,preoperative last albumin levels <35g/L,NYHA ? or ?,SYNTAX score ?29 points were independent risk factors of early postoperative death according to our study.2.Anatomical factor SYNTAX score was a risk factor for early postoperative death in CABG patients.SYNTAX score ?29 was an independent risk factor for early postoperative death in CABG patients.3.Calculation formula of mortality prediction was =ODDS/(1+ODDS)* 100%.ODDS value =EXP(0.736* age stratification +1.297* diabetes history +2.610* critical condition +1.097*creatinine clearance stratification +1.461*preoperative albumin level +1.239* NYHA grading +1.553*SYNTAX score-9.319)Note: age stratification(<75=0;75-79=1;?80=2);Diabetes history(no=0;yes=1);Critical condition(no=0;yes=1);Creatinine clearance stratification(ml/min)(?85=0;50-85=1;<50=2);Preoperative albumin level(g/L)(?35=0;<35=1);NYHA classification(? or ?=0;? or ? = 1);SYNTAX score(<29=0;?29=1)...