title: Changing risk of patients undergoing coronary artery bypass surgery.
abstract: The aim of the present study was to evaluate the changing risk of patients undergoing coronary artery bypass grafting (CABG). Residents of Oulu who underwent coronary angiography and/or revascularization from 1993 to 2006 formed the basis of this community-wide study. One thousand three hundred and forty-nine consecutive patients who underwent CABG have been included in the analysis on changing operative risk and results after CABG. A significant increase in the operative risk occurred in patients who underwent CABG (mean logistic EuroSCORE in 1278 patients: 1993-1997: 3.7%; 1998-2002: 4.6%; 2003-2006: 5.4%; P<0.0001). Thirty-day mortality decreased during the last period (1993-1997: 2.5%; 1998-2002: 3.0%; 2003-2006: 1.6%; P=0.49). The area under the ROC curve of logistic EuroSCORE (1993-1997: 0.86; 1998-2002: 0.78; 2003-2006: 0.99) for prediction of 30-day postoperative mortality markedly improved during the last study period. Despite the increased operative risk, off-pump coronary surgery was associated with lower immediate postoperative mortality rates. Contrary to on-pump surgery, immediate postoperative death occurred after off-pump surgery only in patients with additive EuroSCORE >or=6. The results of this study suggest that improved perioperative care as well as changes in operative strategy are positively faced with the increased burden of comorbidities and operative risk of patients currently undergoing CABG.
authors.affiliation: Department of Surgery, Division of Cardio-thoracic and Vascular Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.forename: Olli-Pekka
authors.initials: OP
authors.lastname: Kangasniemi
authors.forename: Muhammad
authors.initials: M
authors.lastname: Aliasim Mahar
authors.forename: Elsi
authors.initials: E
authors.lastname: Rasinaho
authors.forename: Antti
authors.initials: A
authors.lastname: Satomaa
authors.forename: Valentina
authors.initials: V
authors.lastname: Tiozzo
authors.forename: Matti
authors.initials: M
authors.lastname: Niemelä
authors.forename: Martti
authors.initials: M
authors.lastname: Lepojärvi
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects* / Q000401:mortality; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005260:Female; D005387:Finland / Q000453:epidemiology; D019538:Health Care Surveys; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome