Author + information
- Hazel K. Turner,
- Syed Husain,
- Suneil Aggarwal,
- Julia Flint,
- Karl Norrington,
- Mohamad Barakat,
- Mihir Kelshiker,
- Adrian Cheng and
- Darlington O. Okonko
The utility of surgery revascularization in patients (pts) with a low LVEF and operable coronary disease is unclear, highlighting the importance of risk stratification. Whilst the EuroSCORE and Parsonnet score (PS) are established prognosticators, their relative utility and optimal cut-offs in pts with low LVEF are unknown. Moreover, their utility in coronary artery (CABG) versus isolated valve surgery is unclear.
We analysed inpatient outcomes in 4740 CABG (EuroSCORE 4±3, PS 11±8) and 1278 isolated valve (EuroSCORE 6±3, PS 14±8) pts.
Over a median hospital stay of 7 days, 48 (1.5%), 39 (3.2%) and 29 (9.2%) CABG pts with good (≥50%; n=3220), fair (30-49%; n=1205) or poor (<30%; n=315) LVEFs died. EuroSCORE predicted deaths better than PS only in pts with poor LVEF. On ROC analyses, EuroSCOREs ≤ 4 (AUC 0.81, P<0.0001), ≤ 6 (AUC 0.79, P<0.0001), and ≤ 9 (AUC 0.81, P<0.0001) best predicted survival in pts with good, fair and poor LVEF with 0.4%, 1.2% (Fig A), and 3.3% (Fig B) death rates. In valve pts, 29 (3%) and 15 (5%) with good (n=990) and fair/poor (n=288) LVEFs died over 9 days. EuroSCORE was superior to PS (best AUC for PS 0.65) in all LVEF strata with values ≤ 6 (AUC 0.82, P<0.0001) and ≤ 10 (AUC 0.88, P<0.0001, Fig C) best predictive in pts with good and fair/poor LVEFs and linked to 0.6% and 0% death rates.
A EuroSCORE ≤ 9 appears to identify pts with a poor LVEF at the lowest risk of death post CABG. If externally validated, this cut-off could be utilised to facilitate surgical decisions.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Epidemiology, Risk Modeling and Prediction of Outcomes in Heart Failure
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1308-292
- 2013 American College of Cardiology Foundation