Copyright © 1999 by the European Society of Cardiology.
Severe morbidity after coronary artery surgery: development and validation of a simple predictive clinical score
a Department of Medicine, Hôpital Cardio-vasculaire et Pneumologique Louis Pradel, Lyon, France
b Department of Clinical Pharmacology, Hôpital Cardio-vasculaire et Pneumologique Louis Pradel, Lyon, France
c Department of Anaesthesiology, Hôpital Cardio-vasculaire et Pneumologique Louis Pradel, Lyon, France
d Department of Cardiovascular and Thoracic Surgery, Hôpital Cardio-vasculaire et Pneumologique Louis Pradel, Lyon, France
revised September 28, 1998; accepted September 30, 1998
Abstract
Aims To develop a predictive clinical risk score of post-operative morbidity after coronary artery bypass grafting.
Methods and Results Data were collected retrospectively from 679 patients undergoing emergency or planned bypass surgery between 1 January and 31 December 1996. The incidence of morbidity was 23%. Multivariate stepwise logistic regression analysis on two-thirds of the patients identified eight independent risk factors for severe morbidity. Six of these were pre-operative: symptomatic right heart failure, previous ventricular arrhythmias, previous coronary bypass surgery, chronic pulmonary disease, ST changes on pre-operative electrocardiogram, body mass index <24kg.m–2, and two were intra-operative factors: the surgeon who operated, and the cardiopulmonary bypass time. A predictive clinical risk score was developed with the six pre-operative risk factors. The negative predictive value of the model is 87% and the area under the receiver operating characteristic curve is 0·77. When tested on the remaining patients not used for developing the model, the area under the curve is 0·65.
Conclusion This pre-operative risk score provides a simple method of risk stratification for patients undergoing coronary artery surgery. However, as for all predictive models, the performance of the score decreases when applied to a population other than that used to develop it.
Key Words: Risk factors, coronary artery bypass surgery, morbidity, mortality, logistic models, clinical prediction rule
f1 Correspondence: Dr Patrick Staat, Service Pr Beaune, Unité 61, Hôpital Cardio-vasculaire et Pneumologique Louis Pradel, 59 boulevard Pinel, 69394 Lyon Cedex 03, France.
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