Early and late outcome of myocardial revascularization with and without cardiopulmonary bypass in high risk patients (EuroSCORE > or = 6).
OBJECTIVE
To evaluate 30-day and late results in high risk patients (European score (EuroSCORE) > or = 6) who underwent isolated myocardial revascularization with and without cardiopulmonary bypass (CPB).


METHODS
From November 1994 to December 2001, 1266 patients with EuroSCORE > or = 6 underwent isolated myocardial revascularization. Among them, applying the propensity score, we were able to select 1020 patients operated on without CPB (group A, n=510) and with CPB (group B, n=510) with the same preoperative characteristics. The only differences were the higher incidence of patients with age between 61 and 65 years (9.4% in group A vs. 13.9% in group B, P=0.025) and the lower number of anastomoses/patient in group A (1.8+/-0.9 vs. 2.8+/-0.9, P<0.001). EuroSCORE were identical in both groups (7.8%).


RESULTS
Thirty-day mortality was higher in group B (5.9 vs. 3.1%, P=0.035). Group A showed a lower incidence of cerebrovascular accidents (CVAs) (0.6 vs. 3.1%, P=0.003), whereas incidence of acute myocardial infarction (AMI) was similar (2.0% in group A vs. 2.5% in group B, P=ns). Early negative primary end-points and early major events incidences were higher in group B (8.2 vs. 3.9%, P=0.004, and 14.5 vs. 7.1%, P<0.001, respectively). Stepwise logistic regression confirmed that CPB was an independent predictor for higher early mortality (Odds ratio (OR) 2.0) and CVA, negative primary end-points and early major events incidences (OR 4.6, 2.3 and 2.4, respectively). Five-year freedom from the events explored (death due to any cause, cardiac death, AMI, AMI on a grafted area, redo/percutaneous transluminal coronary angioplasty (PTCA), redo/PTCA on a grafted area, target cardiac events (cardiac death, AMI in a grafted area and redo/PTCA in a grafted area) and any event were similar in both groups.


CONCLUSIONS
In high risk patients myocardial revascularization without CPB shows better early outcome and similar clinical late results.
Calafiore
Antonio Maria
AM
Department of Cardiology and Cardiac Surgery, University G. D'Annunzio, S. Camillo de' Lellis Hospital, via C. Forlanini, 50, 66100 Chieti, Italy. calafiore@unich.it
Di Mauro
Michele
M
Canosa
Carlo
C
Di Giammarco
Gabriele
G
Iaco
Angela Lorena
AL
Contini
Marco
M
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass; D000075202:Contraindications; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D018579:Patient Selection; D011183:Postoperative Complications; D011184:Postoperative Period; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome