Kinnunen Eeva-Maija, Mosorin Matti-Aleksi, Perrotti Andrea, Ruggieri Vito G, Svenarud Peter, Dalén Magnus, Onorati Francesco, Faggian Giuseppe, Santarpino Giuseppe, Maselli Daniele, Dominici Carmelo, Nardella Saverio, Musumeci Francesco, Gherli Riccardo, Mariscalco Giovanni, Masala Nicola, Rubino Antonino S, Mignosa Carmelo, De Feo Marisa, Della Corte Alessandro, Bancone Ciro, Chocron Sidney, Gatti Giuseppe, Juvonen Tatu, Biancari Fausto
Department of Surgery, Oulu University Hospital, Oulu, Finland.
Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France.
J Cardiothorac Vasc Anesth. 2016 Apr;30(2):330-7. doi: 10.1053/j.jvca.2015.09.019. Epub 2015 Sep 26.
The authors aimed to validate the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) classification of postoperative complications in patients undergoing coronary artery bypass grafting (CABG).
Retrospective, observational study.
University hospital.
A total of 2,764 patients with severe coronary artery disease. Complete baseline, operative, and postoperative data were available for patients who underwent isolated CABG.
Isolated CABG.
The E-CABG complication classification was used to stratify the severity and prognostic impact of adverse postoperative events. Primary outcome endpoints were 30-day, 90-day, and long-term all-cause mortality. The secondary outcome endpoints was the length of intensive care unit stay. Both the E-CABG complication grades and additive score were predictive of 30-day (area under the receiver operating characteristics curve 0.866, 95% confidence interval [CI] 0.829-0.903; and 0.876; 95% CI 0.844-0.908, respectively) and 90-day (area under the receiver operating characteristics curve 0.850, 95% CI 0.812-0.887; and 0.863, 95% CI 0.829-0.897, respectively) all-cause mortality. The complication grades were independent predictors of increased mortality at actuarial (log-rank: p<0.0001) and adjusted analysis (p<0.0001; grade 1: hazard ratio [HR] 1.757, 95% CI 1.111-2.778; grade 2: HR 2.704, 95% CI 1.664-4.394; grade 3: HR 5.081, 95% CI 3.148-8.201). When patients who died within 30 days were excluded from the analysis, this grading method still was associated with late mortality (p<0.0001). The grading method (p<0.0001) and the additive score (rho, 0.514; p<0.0001) were predictive of the length of intensive care unit stay.
The E-CABG postoperative complication classification seems to be a promising tool for stratifying the severity and prognostic impact of postoperative complications in patients undergoing cardiac surgery.
作者旨在验证欧洲冠状动脉旁路移植术多中心研究（E-CABG）对冠状动脉旁路移植术（CABG）患者术后并发症的分类。
回顾性观察研究。
大学医院。
共2764例严重冠状动脉疾病患者。接受单纯CABG的患者可获得完整的基线、手术及术后数据。
单纯CABG。
采用E-CABG并发症分类对术后不良事件的严重程度及预后影响进行分层。主要结局终点为30天、90天及长期全因死亡率。次要结局终点为重症监护病房住院时间。E-CABG并发症分级及累加评分均能预测30天（受试者工作特征曲线下面积分别为0.866，95%置信区间[CI]0.829 - 0.903；及0.876，95%CI 0.844 - 0.908）和90天（受试者工作特征曲线下面积分别为0.850，95%CI 0.812 - 0.887；及0.863，95%CI 0.829 - 0.897）全因死亡率。并发症分级是精算（对数秩检验：p<0.0001）及校正分析（p<0.0001；1级：风险比[HR]1.757，95%CI 1.111 - 2.778；2级：HR 2.704，95%CI 1.664 - 4.394；3级：HR 5.081，95%CI 3.148 - 8.201）死亡率增加的独立预测因素。当将30天内死亡的患者排除在分析之外时，这种分级方法仍与晚期死亡率相关（p<0.0001）。分级方法（p<0.0001）及累加评分（rho值为0.514；p<0.0001）能预测重症监护病房住院时间。
E-CABG术后并发症分类似乎是一种很有前景的工具，可用于对心脏手术患者术后并发症的严重程度及预后影响进行分层。
