[Prospective risk analysis in patients submitted to myocardial revascularization surgery].
OBJECTIVE
To perform a stratified risk analysis in Myocardial Revascularization Surgery (MRS).


METHODS
814 patients were prospectively studied by applying two prognostic indexes (PI): Parsonnet and Modified Higgins. The Higgins PI was modified by substituting the variable "cardiac index value" by "low cardiac output syndrome" at the Intensive Care Unit (ICU) admission. The discriminatory capacity for morbimortality of both indexes was analyzed by ROC (receiver operating characteristic) curve. Logistic reaction identified the associated factors, independently from the events.


RESULTS
Mortality and morbidity rates were 5.9% and 35.5%, respectively. The Modified Higgins PI, which analyzes pre- and intra-operative and physiological variables at the ICU admission showed areas under the ROC curve of 77% for mortality and 67% for morbidity. The Parsonnet PI, which only analyzes pre-operative variables, showed areas of 62.2% and 62.4%, respectively. Twelve variables were characterized as independent prognostic factors: age, diabetes mellitus, low body surface, creatinine levels (>1.5 mg/dL), hypoalbuminemia, non-elective surgery, prolonged time of extracorporeal circulation (ECC), necessity of post-ECC intra-aortic balloon, low cardiac output syndrome at the ICU admission, elevated cardiac frequency, decrease in serum bicarbonate concentrations and increase of the alveolar-arterial oxygen gradient within this period.


CONCLUSIONS
The Modified Higgins PI showed to be superior to the Parsonnet PI at the surgical risk stratification, showing the importance of the analysis of intraoperative events and physiological variables at the patient's ICU admission, when prognostic definition is achieved.
Bianco
Antonio Carlos Mugayar
AC
Instituto Dante Pazzanese de Cardiologia, Rua Pelotas 323/113, 04012-001 São Paulo, SP. mugayarb@terra.com.br
Timerman
Ari
A
Paes
Angela Tavares
AT
Gun
Carlos
C
Ramos
Rui Fernando
RF
Freire
Ronald Brewer Pereira
RB
Vela
César Nicolas Conde
CN
Fagundes Junior
Antonio Aurélio de Paiva
AA
Martins
Luís Cláudio Behrmann
LC
Piegas
Leopoldo Soares
LS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000401:mortality*