Jump to ContentJump to Main Navigation
Show Summary Details

Open Medicine

formerly Central European Journal of Medicine

IMPACT FACTOR increased in 2015: 0.190
5-year IMPACT FACTOR: 0.221

SCImago Journal Rank (SJR) 2015: 0.140
Source Normalized Impact per Paper (SNIP) 2015: 0.154
Impact per Publication (IPP) 2015: 0.197

Open Access
See all formats and pricing

Select Volume and Issue
Loading journal volume and issue information...

Coronary artery bypass surgery in patients with low EuroSCORE preoperative risk

1Clinical Hospital Center Bezanijska Kosa, Faculty of Medicine, University of Belgrade, 11000, Belgrade, Serbia

2The Clinic for Cardiovascular Surgery, Clinical Center Serbia, Faculty of Medicine, University of Belgrade, 11000, Belgrade, Serbia

3Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000, Belgrade, Serbia

© 2012 Versita Warsaw. This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License. (CC BY-NC-ND 3.0)

Citation Information: Open Medicine. Volume 7, Issue 3, Pages 388–395, ISSN (Online) 2391-5463, DOI: 10.2478/s11536-011-0164-4, March 2012

Publication History

Published Online:


Patients with EuroSCORE <2 are usually considered to have a low surgical risk and the lowest mortality. In our study preoperative factors in a group of 250 consecutive low-risk patients (EuroSCORE<2), who underwent first isolated coronary artery by-pass surgery during 1999 and 2000., were analyzed. Cumulative follow-up period was 1178.48 patient-years and the primary clinical outcome was all-cause mortality. Patients’ average age was 59.2±7.5 yr. The following preoperative risk factors of increased 5-year mortality were identified: older age (P<0.001), smoking, prior non-recent myocardial infarction and reinfarction, anteroseptal localization of myocardial infarction (P<0.001), poor ejection fraction<=35% (P<0.001), dilatative cardiomyopathy (P<0.001), wall motion systolic index 〉2 (P<0.001), left atrial dilatation (P<0.001), mitral regurgitation more than 2+ (P<0.001), presence of left main disease, triple vessel coronary artery disease (P<0.001), absence of collaterals (P<0.001) and presence of more than 3 distal anastomoses. Through the present study it has been shown that it is possible to identify a subgroup of patients with low operative mortality and excellent 5-year survival after surgical treatment for coronary artery bypass surgery using preoperative clinical, echocardiographic, coronarographic and intraoperative data, even in difficult conditions of the civil war in the region.

Keywords: Cardiac surgery; Coronary artery bypass; Preoperative risk prediction; EuroSCORE

  • [1] Nashef S.A., Roques F., Michel P., Gauducheau E., Lemeshow S., Salamon R. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg, 1999, 16, 9–13 http://dx.doi.org/10.1016/S1010-7940(99)00134-7 [CrossRef]

  • [2] Parsonnet V., Dean D., Bernstein A.D. A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease. Circulation, 1989, 79(Pt 2), I3–I12

  • [3] Biancari F., Kangasniemi O.P., Luukkonen J., Vuorisalo S., Satta J., Pokela R., et al. EuroSCORE predicts immediate and late outcome after coronary artery bypass surgery. Ann Thorac Surg, 2006, 82, 57–61 http://dx.doi.org/10.1016/j.athoracsur.2005.11.039 [CrossRef]

  • [4] Roques F., Nashef S.A., Michel P., Gauducheau E., de Vincentiis C., Baudet E., et al. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg, 1999, 15, 816–822 http://dx.doi.org/10.1016/S1010-7940(99)00106-2

  • [5] Yap C.H., Reid C., Yii M., Rowland M.A., Mohajeri M., Skillington P.D., Seevanayagam S. et al. Validation of the EuroSCORE model in Australia. Eur J Cardiothorac Surg, 2006, 29, 441–446 http://dx.doi.org/10.1016/j.ejcts.2005.12.046 [CrossRef]

  • [6] Nashef S.A., Roques F., Hammill B.G., Peterson E.D., Michel P., Grover F.L., et al. EuroSCORE Project Group. Validation of European system for cardiac operative risk evaluation (EuroSCORE) in North American cardiac surgery. Eur J Cardiothorac Surg, 2002, 22, 101–105 http://dx.doi.org/10.1016/S1010-7940(02)00208-7 [CrossRef]

  • [7] Kawachi Y., Nakashima A., Toshima Y., Arinaga K., Kawano H. Evaluation of the quality of cardiovascular surgery care using risk stratification analysis according to the EuroSCORE additive model. Circ J, 2002, 66, 145–148 http://dx.doi.org/10.1253/circj.66.145 [CrossRef]

  • [8] Chen X. Current status of coronary artery bypass surgery. Chin Med J (Engl), 2009, 122(2), 126–128

  • [9] Park M.K., Park S.W., Lee S.C., Lee S.H., Sung K., Park K.H., et al. Clinical outcome of cardiac surgery in octogenarians. J Korean Med Sci, 2005, 20(5), 747–751 http://dx.doi.org/10.3346/jkms.2005.20.5.747 [CrossRef]

  • [10] Srinivasan A.K., Oo A.Y., Grayson A.D., Lowe R., Perry R.A., Fabri B.M., et al. Mid-term survival after cardiac surgery in elderly patients: analysis of predictors for increased mortality. Interact Cardiovasc Thorac Surg, 2004, 3(2), 289–293 http://dx.doi.org/10.1016/j.icvts.2004.01.002 [CrossRef]

  • [11] Na K.Y., Kim C.W., Song Y.R., Chin H.J., Chae D.W. The association between kidney function, coronary artery disease, and clinical outcome in patients undergoing coronary angiography. J Korean Med Sci, 2009, 24, S87–S94. http://dx.doi.org/10.3346/jkms.2009.24.S1.S87 [Web of Science] [CrossRef]

  • [12] Patel M.R., Dehmer G.J., Hirshfeld J.W., Smith P.K., Spertus J.A. ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization: a report by the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, and the American Society of Nuclear Cardiology Endorsed by the American Society of Echocardiography, the Heart Failure Society of America, and the Society of Cardiovascular Computed Tomography. J Am Coll Cardiol, 2009, 53, 530–553 http://dx.doi.org/10.1016/j.jacc.2008.10.005 [CrossRef]

  • [13] Cheitlin M.D., Armstrong W.F., Aurigemma G.P., Beller G.A., Bierman F.Z., Davis J.L., et al. ACC; AHA; ASE. ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). J Am Soc Echocardiogr, 2003, 16(10), 1091–1110

  • [14] The Committee of Chinese CABG Registry Study, Hu S.S. The Chinese coronary artery bypass grafting registry report: 2004–2005. Zhonghua Xin Xue Guan Bing Za Zhi. 2009, 37(3): 240–243

  • [15] Baslaim G., Bashore J., Alhoroub K. Impact of obesity on early outcomes after cardiac surgery: experience in a Saudi Arabian center. Ann Thorac Cardiovasc Surg, 2008, 14(6), 369–375

  • [16] Gopaldas R.R., Chu D., Dao T.K., Huh J., Lemaire S.A., Coselli J.S., et al. Predictors of surgical mortality and discharge status after coronary artery bypass grafting in patients 80 years and older. Am J Surg, 2009, 198(5), 633–638 http://dx.doi.org/10.1016/j.amjsurg.2009.07.007 [CrossRef]

  • [17] Herman C., Karolak W., Yip A.M., Buth K.J., Hassan A., Légaré J.F. Predicting prolonged intensive care unit length of stay in patients undergoing coronary artery bypass surgery—development of an entirely preoperative scorecard. Interact Cardiovasc Thorac Surg, 2009, 9(4), 654–658 http://dx.doi.org/10.1510/icvts.2008.199521 [CrossRef]

  • [18] Danner B.C., Didilis V.N., Stojanovic T., Popov A., Grossmann M., Seipelt R., et al. A three-group model to predict mortality in emergent coronary artery bypass graft surgery. Ann Thorac Surg, 2009, 88(5), 1433–1439 http://dx.doi.org/10.1016/j.athoracsur.2009.06.059 [CrossRef] [Web of Science]

  • [19] Oktar G.L., Imren V.Y., Erer D., Iriz E., Gokgoz L., Soncul H. Coronary artery bypass graft surgery in the elderly patients. Cent. Eur. J. Med,, 4(2), 2009, 218–221 http://dx.doi.org/10.2478/s11536-008-0077-z [CrossRef]

  • [20] Sharoni E., Kogan A., Medalion B., Stamler A., Snir E., Porat E. Is gender an independent risk factor for coronary bypass grafting? Thorac Cardiovasc Surg, 2009, 57(4), 204–208 http://dx.doi.org/10.1055/s-0029-1185367 [CrossRef]

  • [21] Peric V., Borzanovic M., Jovanovic A., Stolic R., Sovtic S., Trajkovic G. The relationship between EuroSCORE preoperative risk prediction and quality of life changes after coronary artery by-pass surgery. Interact Cardiovasc Thorac Surg. 2005, 4(6), 622–626 http://dx.doi.org/10.1510/icvts.2005.109546 [CrossRef]

  • [22] Ghali J.K. CABG in patients with left ventricular dysfunction. N Engl J Med, 2011; 365(5), 468 http://dx.doi.org/10.1056/NEJMc1106549 [CrossRef]

  • [23] Goland S., Czer L.S., Siegel R.J., DeRobertis M.A., Mirocha J., Zivari K., et al. Coronary revascularization alone or with mitral valve repair: outcomes in patients with moderate ischemic mitral regurgitation. Tex Heart Inst J, 2009, 36(5): 416–424

  • [24] Silberman S., Eldar O., Oren A., Tauber R., Fink D., Klutstein M.W., et al. Surgery for ischemic mitral regurgitation: should the valve be repaired? J Heart Valve Dis. 2011, 20(2), 129–135

  • [25] Toumpoulis I.K., Chamogeorgakis T.P., Angouras D.C., Swistel D.G., Anagnostopoulos C.E., Rokkas C.K. The impact of left ventricular hypertrophy on early and long-term survival after coronary artery bypass grafting. Int J Cardiol, 2009, 135(1), 36–42 http://dx.doi.org/10.1016/j.ijcard.2008.03.013 [CrossRef]

  • [26] Ribera A., Ferreira-González I., Cascant P., Marsal J.R., Romero B., Pedrol D., et al. ARCA Study Investigators. Survival, clinical status and quality of life five years after coronary surgery. The ARCA study.Rev Esp Cardiol, 2009, 62(6), 642–651 http://dx.doi.org/10.1016/S0300-8932(09)71331-4 [Web of Science] [CrossRef]

Comments (0)

Please log in or register to comment.