Abstract

VRANCIC, Juan M. et al. Predictors of Risk in Off-Pump Coronary Surgery: Analysis of 1.000 Patients. Rev. argent. cardiol. [online]. 2006, vol.74, n.6, pp.357-366. ISSN 1850-3748.

Objective To analyze the postoperative results and identify predictors of 30 day-morbidity and mortality in off-pump (OP) coronary revascularization surgery (CRS). Material and methods One thousand consecutive patients, operated between January 1997 and August 2005 exclusively with off-pump surgery, were included in the study. Results Patients' mean age was 64.7 ± 15.7 years and 27% were older than age 70; 86% were men. Overall mortality was 3.3% (elective OP-CRS: 1.8%; non-elective: 6%; p < 0.001). Mortality according to Euroscore was as follows: low risk 1.42%, intermediate risk 2.5% and high risk 8.04% (p< 0.001). On multivariate analysis, independent predictors of hospital mortality were age (OR 1.01, p = 0.013, 95% CI 1.00-1.03), prior CRS (OR 3.87, p = 0.01, 95% CI 1.33-11.28), unstable angina (OR 4.97; p = 0.01; 95% CI 1.41-17.48), non-elective surgery (OR 2.36, p = 0.02, 95% CI 1.09-5.09), conversion to on-pump surgery (OR 5.91, p = 0.01, 95% CI 1.43-24.45). Major complications were seen in 5.4% of patients. Factors identified as independent predictors of morbidity were conversion to on-pump CRS (OR 15.96, p < 0.001, 95% CI 5.24-48.53), unstable angina (OR 3.01, p = 0.01, 95% CI 1.30-7.03) and the presence of more severe coronary disease (OR 1.39, p = 0.04, 95% CI 1-1.9). Conclusions Off-pump CRS had a low incidence of postoperative morbidity and mortality. The presence of unstable angina, nonelective surgery, conversion to on-pump CRS, prior CRS and age were identified as predictors of mortality. The presence of more serious coronary disease, the conversion to on-pump CRS and unstable angina were predictors of postoperative morbidity.

Keywords : Coronary surgery; Off-pump coronary surgery; Predictors of risk.