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Impact of early quantitative morbidity on 1-year outcomes in coronary artery bypass graft surgery
Interdisciplinary CardioVascular and Thoracic Surgery ( IF 1.978 ) Pub Date : 2021-10-28 , DOI: 10.1093/icvts/ivab316
Mélanie Hébert 1 , André Lamy 2 , Nicolas Noiseux 3 , Louis-Mathieu Stevens 3 ,
Affiliation  

OBJECTIVES We applied the Clavien-Dindo Complications Classification (CDCC) and the Comprehensive Complication Index (CCI) to the CORONARY trial to assess whether quantitative early morbidity affects outcomes at 1 year. METHODS All postoperative hospitalization and 30-day follow-up complications were assigned a CDCC grade. CCI were calculated for all patients (n = 4752). Kaplan–Meier analysis examined 1-year mortality and 1-year co-primary outcome (i.e. death, non-fatal stroke, non-fatal myocardial infarction, new-onset renal failure requiring dialysis or repeat coronary revascularization) by CDCC grade. Multivariable logistic regression evaluated the predictive value of CCI for both outcomes. RESULTS For off-pump and on-pump coronary artery bypass graft surgery, median CDCC were 1 [interquartile range: 0, 2] and 2 [1, 2] (P < 0.001), while median CCI were 8.7 [0, 22.6] and 20.9 [8.7, 29.6], respectively (P < 0.001). In on-pump, there were more grade I and grade II complications, particularly grade I and II transfusions (P < 0.001) and grade I acute kidney injury (P = 0.039), and more grade IVa respiratory failures (P = 0.047). Patients with ≥IIIa complications had greater cumulative 1-year mortality (P < 0.001). The median CCI was 8.7 [0, 22.6] in patients who survived and 22.6 [8.7, 44.3] in patients who died at 1 year (P < 0.001). The CCI remained an independent risk factor for 1-year mortality and 1-year co-primary outcome after multivariable adjustment (P < 0.001). CONCLUSIONS On-pump coronary artery bypass graft surgery had a greater number of complications in the early postoperative period, likely driven by transfusions, respiratory outcomes and acute kidney injury. This affects 1-year outcomes. Similar analyses have not yet been used to compare both techniques and could prove useful to quantify procedural morbidity. Clinical trial registration https://www.clinicaltrials.gov/ct2/show/NCT00463294; Unique Identifier: NCT00463294.

中文翻译:

早期定量发病率对冠状动脉搭桥手术 1 年结果的影响

目的 我们将 Clavien-Dindo 并发症分类 (CDCC) 和综合并发症指数 (CCI) 应用于冠状动脉试验,以评估定量早期发病率是否会影响 1 年的结果。方法 所有术后住院和 30 天随访并发症均被指定为CDCC 等级。计算所有患者的 CCI (n = 4752)。Kaplan-Meier 分析检查了CDCC 分级的1 年死亡率和1 年共同主要结局(即死亡、非致死性卒中、非致死性心肌梗死、需要透析的新发肾衰竭或重复冠状动脉血运重建)。多变量逻辑回归评估了 CCI 对两种结果的预测价值。结果 对于非体外循环和非体外循环冠状动脉旁路移植术,CDCC 中位数为 1 [四分位距:0, 2] 和 2 [1, 2] (P < 0.001),而中位 CCI 分别为 8.7 [0, 22.6] 和 20.9 [8.7, 29.6] (P < 0.001)。在泵上,有更多的 I 级和 II 级并发症,特别是 I 级和 II 级输血(P < 0.001)和 I 级急性肾损伤(P = 0.039),以及更多 IVa 级呼吸衰竭(P = 0.047) . ≥IIIa 并发症的患者 1 年累积死亡率更高(P < 0.001)。存活患者的中位 CCI 为 8.7 [0, 22.6],1 年时死亡的患者中位 CCI 为 22.6 [8.7, 44.3] (P < 0.001)。在多变量调整后,CCI 仍然是 1 年死亡率和 1 年共同主要结果的独立危险因素(P < 0.001)。结论 体外循环冠状动脉旁路移植手术在术后早期有更多的并发症,可能是由输血引起的,呼吸系统结局和急性肾损伤。这会影响 1 年的结果。尚未使用类似的分析来比较这两种技术,并且可能证明对量化程序发病率很有用。临床试验注册 https://www.clinicaltrials.gov/ct2/show/NCT00463294;唯一标识符:NCT00463294。
更新日期:2021-10-28
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