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A simple score to assess mortality risk in patients waiting for coronary artery bypass grafting

Rexius, H ; Brandrup-Wognsen, G ; Nilsson, Johan LU ; Oden, A and Jeppsson, A (2006) In Annals of Thoracic Surgery 81(2). p.577-582
Abstract
Background. Independent risk factors for death in patients waiting for elective coronary artery bypass surgery have previously been identified. A prioritization where these factors are considered may potentially reduce waiting list mortality. A simple score based on the risk factors was constructed and validated. Methods. A scoring system based on risk factors in 5,864 consecutive patients operated from 1995 to 1999 was constructed. The following factors were included in the score: unstable angina (3 points [p]), left main stenosis (2p), concomitant aortic valve disease (2p), operative risk (0-2p), left ventricular ejection fraction (0-2p), and male gender (1p). The score was retrospectively validated in 5,167 new patients operated from... (More)
Background. Independent risk factors for death in patients waiting for elective coronary artery bypass surgery have previously been identified. A prioritization where these factors are considered may potentially reduce waiting list mortality. A simple score based on the risk factors was constructed and validated. Methods. A scoring system based on risk factors in 5,864 consecutive patients operated from 1995 to 1999 was constructed. The following factors were included in the score: unstable angina (3 points [p]), left main stenosis (2p), concomitant aortic valve disease (2p), operative risk (0-2p), left ventricular ejection fraction (0-2p), and male gender (1p). The score was retrospectively validated in 5,167 new patients operated from 1999 to 2003. Based on the sum of risk score points, the patients were divided into three risk groups: low risk (0-2p), intermediate risk (3-5p) and high risk (>= 6p). The risk groups were related to waiting list mortality and clinical priority (imperative, urgent, and routine). Results. Median waiting time was 33 days. Forty-two patients (0.8%) died while waiting for surgery (5.2 deaths/100 waiting years). Of the patients, 2,406 (47%) were low risk, 1,990 (38%) intermediate risk, and 771 (15%) high risk. Mortality incidence in the high-risk group was fivefold higher than in the intermediate group and 25-fold higher than in the low-risk group (32, 7, and 1.3 deaths/100 waiting years, respectively, p < 0.001 between all groups). Twenty-three percent of the patients in the high-risk group had not been given imperative clinical priority. Conclusions. The score system identifies patients with increased risk of death while waiting for coronary artery bypass grafting. The score may be used to facilitate and improve the prioritization process. (Less)
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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Annals of Thoracic Surgery
volume
81
issue
2
pages
577 - 582
publisher
Elsevier
external identifiers
  • wos:000235142400028
  • pmid:16427855
  • scopus:31044436030
  • pmid:16427855
ISSN
1552-6259
DOI
10.1016/j.athoracsur.2005.08.032
language
English
LU publication?
yes
id
4f3e05c6-6b43-41ff-b2ab-f41f21368d90 (old id 417984)
alternative location
http://ats.ctsnetjournals.org/cgi/content/abstract/81/2/577
date added to LUP
2016-04-01 11:53:14
date last changed
2020-12-27 05:52:44
@article{4f3e05c6-6b43-41ff-b2ab-f41f21368d90,
  abstract     = {Background. Independent risk factors for death in patients waiting for elective coronary artery bypass surgery have previously been identified. A prioritization where these factors are considered may potentially reduce waiting list mortality. A simple score based on the risk factors was constructed and validated. Methods. A scoring system based on risk factors in 5,864 consecutive patients operated from 1995 to 1999 was constructed. The following factors were included in the score: unstable angina (3 points [p]), left main stenosis (2p), concomitant aortic valve disease (2p), operative risk (0-2p), left ventricular ejection fraction (0-2p), and male gender (1p). The score was retrospectively validated in 5,167 new patients operated from 1999 to 2003. Based on the sum of risk score points, the patients were divided into three risk groups: low risk (0-2p), intermediate risk (3-5p) and high risk (&gt;= 6p). The risk groups were related to waiting list mortality and clinical priority (imperative, urgent, and routine). Results. Median waiting time was 33 days. Forty-two patients (0.8%) died while waiting for surgery (5.2 deaths/100 waiting years). Of the patients, 2,406 (47%) were low risk, 1,990 (38%) intermediate risk, and 771 (15%) high risk. Mortality incidence in the high-risk group was fivefold higher than in the intermediate group and 25-fold higher than in the low-risk group (32, 7, and 1.3 deaths/100 waiting years, respectively, p &lt; 0.001 between all groups). Twenty-three percent of the patients in the high-risk group had not been given imperative clinical priority. Conclusions. The score system identifies patients with increased risk of death while waiting for coronary artery bypass grafting. The score may be used to facilitate and improve the prioritization process.},
  author       = {Rexius, H and Brandrup-Wognsen, G and Nilsson, Johan and Oden, A and Jeppsson, A},
  issn         = {1552-6259},
  language     = {eng},
  number       = {2},
  pages        = {577--582},
  publisher    = {Elsevier},
  series       = {Annals of Thoracic Surgery},
  title        = {A simple score to assess mortality risk in patients waiting for coronary artery bypass grafting},
  url          = {http://dx.doi.org/10.1016/j.athoracsur.2005.08.032},
  doi          = {10.1016/j.athoracsur.2005.08.032},
  volume       = {81},
  year         = {2006},
}