Brascia Debora, Reichart Daniel, Onorati Francesco, Perrotti Andrea, Ruggieri Vito G, Bounader Karl, Verhoye Jean Philippe, Santarpino Giuseppe, Fischlein Theodor, Maselli Daniele, Dominici Carmelo, Mariscalco Giovanni, Gherli Riccardo, Rubino Antonino S, De Feo Marisa, Bancone Ciro, Gatti Giuseppe, Santini Francesco, Dalén Magnus, Saccocci Matteo, Faggian Giuseppe, Tauriainen Tuomas, Kinnunen Eeva-Maija, Nicolini Francesco, Gherli Tiziano, Rosato Stefano, Biancari Fausto
Department of Surgery, Oulu University Hospital, Oulu, Finland.
Hamburg University Heart Center, Hamburg, Germany.
Am J Cardiol. 2017 Mar 1;119(5):727-733. doi: 10.1016/j.amjcard.2016.11.027. Epub 2016 Dec 3.
Perioperative bleeding is a determinant of poor outcome in patients undergoing coronary artery bypass grafting (CABG), but there is a lack of adequate stratification of its severity. The ability of the European registry of Coronary Artery Bypass Grafting (E-CABG), Universal Definition of Perioperative Bleeding (UDPB), Study of Platelet Inhibition and Patient Outcomes (PLATO), Clopidogrel and Aspirin Optimal Dose Usage to Reduce Recurrent Events-Seventh Organization to Assess Strategies in Ischemic Syndromes (CURRENT-OASIS 7), Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q Wave Coronary Events (ESSENCE), and SafeTy and Efficacy of Enoxaparin in Percutaneous coronary intervention patients, an internationaL randomized Evaluation (STEEPLE) bleeding classifications to predict early mortality, stroke, acute kidney injury (AKI) stage 3, and deep sternal wound infection/mediastinitis was investigated in 3,730 patients from the prospective, multicentre E-CABG registry. Increasing grades of the E-CABG, UDPB, PLATO, and CURRENT-OASIS 7 classifications were associated with increasing risks of early mortality, had similar receiver-operating characteristic area under the curves (>0.7), and were predictive also when adjusted for EuroSCORE II. The E-CABG and UDPB classifications had satisfactory area under the curves (>0.6) in predicting stroke, AKI stage 3, and deep sternal wound infection/mediastinitis even when adjusted for EuroSCORE II. The PLATO and CURRENT-OASIS 7 classifications had similar predictive ability for stroke and AKI stage 3 as confirmed by multivariate analysis adjusted for EuroSCORE II but showed inferior ability in predicting severe wound infection compared to the E-CABG and UDPB classifications. The STEEPLE and ESSENCE classifications had a poor ability of predicting all these adverse events. Decision curve analysis showed a benefit of the E-CABG bleeding classification over the other classifications in predicting all adverse events. In conclusion, the E-CABG, UDPB, PLATO, and CURRENT-OASIS 7 bleeding classifications have a satisfactory ability in predicting adverse events after CABG. Decision curve analysis showed that the E-CABG bleeding classification had the best predictive performance.
围手术期出血是冠状动脉旁路移植术（CABG）患者预后不良的一个决定因素，但目前对其严重程度缺乏充分的分层。本研究在一项前瞻性、多中心的欧洲冠状动脉旁路移植术登记研究（E-CABG）的3730例患者中，调查了欧洲冠状动脉旁路移植术登记研究（E-CABG）、围手术期出血通用定义（UDPB）、血小板抑制与患者预后研究（PLATO）、氯吡格雷和阿司匹林最佳剂量用于减少复发性事件——第七次缺血综合征评估策略组织研究（CURRENT-OASIS 7）、非Q波冠状动脉事件中皮下注射依诺肝素的有效性和安全性研究（ESSENCE）以及依诺肝素在经皮冠状动脉介入治疗患者中的安全性和有效性国际随机评估研究（STEEPLE）的出血分类预测早期死亡、卒中、3期急性肾损伤（AKI）和深部胸骨伤口感染/纵隔炎的能力。E-CABG、UDPB、PLATO和CURRENT-OASIS 7分类等级的增加与早期死亡风险的增加相关，其曲线下面积具有相似的受试者工作特征（>0.7），并且在根据欧洲心脏手术风险评估系统II（EuroSCORE II）进行调整后仍具有预测性。即使在根据EuroSCORE II进行调整后，E-CABG和UDPB分类在预测卒中、3期AKI和深部胸骨伤口感染/纵隔炎方面仍具有令人满意的曲线下面积（>0.6）。经EuroSCORE II调整的多变量分析证实，PLATO和CURRENT-OASIS 7分类对卒中和3期AKI具有相似的预测能力，但与E-CABG和UDPB分类相比，其在预测严重伤口感染方面的能力较差。STEEPLE和ESSENCE分类对所有这些不良事件的预测能力较差。决策曲线分析显示，在预测所有不良事件方面，E-CABG出血分类比其他分类更具优势。总之，E-CABG、UDPB、PLATO和CURRENT-OASIS 7出血分类在预测CABG术后不良事件方面具有令人满意的能力。决策曲线分析表明，E-CABG出血分类具有最佳的预测性能。
