title: [Prospective risk analysis in patients submitted to myocardial revascularization surgery].
abstract: 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.
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, Rua Pelotas 323/113, 04012-001 São Paulo, SP. mugayarb@terra.com.br
authors.forename: Antonio Carlos Mugayar
authors.initials: AC
authors.lastname: Bianco
authors.forename: Ari
authors.initials: A
authors.lastname: Timerman
authors.forename: Angela Tavares
authors.initials: AT
authors.lastname: Paes
authors.forename: Carlos
authors.initials: C
authors.lastname: Gun
authors.forename: Rui Fernando
authors.initials: RF
authors.lastname: Ramos
authors.forename: Ronald Brewer Pereira
authors.initials: RB
authors.lastname: Freire
authors.forename: César Nicolas Conde
authors.initials: CN
authors.lastname: Vela
authors.forename: Antonio Aurélio de Paiva
authors.initials: AA
authors.lastname: Fagundes Junior
authors.forename: Luís Cláudio Behrmann
authors.initials: LC
authors.lastname: Martins
authors.forename: Leopoldo Soares
authors.initials: LS
authors.lastname: Piegas
mesh_terms: 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*