title: A clinical score to predict the need for intraaortic balloon pump in patients undergoing coronary artery bypass grafting.
abstract: BACKGROUND
  There is no accepted consensus on the definition of high-risk patients who may benefit from the use of intraaortic balloon pump (IABP) in coronary artery bypass grafting (CABG). The aim of this study was to develop a risk model to identify high-risk patients and predict the need for IABP insertion during CABG.
  
  
  METHODS
  From April 1996 to December 2006, 8,872 consecutive patients underwent isolated CABG; of these 182 patients (2.1%) received intraoperative or postoperative IABP. The scoring risk model was developed in 4,575 patients (derivation dataset) and validated on the remaining patients (validation dataset). Predictive accuracy was evaluated by the area under the receiver operating characteristic curve.
  
  
  RESULTS
  Mortality was 1% in the entire cohort and 18.7% (22 patients) in the group which received IABP. Multivariable analysis showed that age greater than 70 years, moderate and poor left ventricular dysfunction, previous cardiac surgery, emergency operation, left main disease, Canadian Cardiovascular Society 3-4 class, and recent myocardial infarction were independent risk factors for the need of IABP insertion. Three risk groups were identified. The observed probability of receiving IABP and mortality in the validation dataset was 36.4% and 10% in the high-risk group (score >14), 10.9% and 2.8% in the medium-risk group (score 7 to 13), and 1.7% and 0.7% in the low-risk group (score 0 to 6).
  
  
  CONCLUSIONS
  This simple clinical risk model based on preoperative clinical data can be used to identify high-risk patients who may benefit from elective insertion of IABP during CABG.
authors.affiliation: The Bristol Heart Institute, University of Bristol, Bristol, United Kingdom. antoniomiceli79@alice.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Miceli
authors.forename: Simon M J
authors.initials: SM
authors.lastname: Duggan
authors.forename: Radek
authors.initials: R
authors.lastname: Capoun
authors.forename: Francesco
authors.initials: F
authors.lastname: Romeo
authors.forename: Massimo
authors.initials: M
authors.lastname: Caputo
authors.forename: Gianni D
authors.initials: GD
authors.lastname: Angelini
mesh_terms: D000368:Aged; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D005260:Female; D005544:Forecasting; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000706:statistics & numerical data*; D008297:Male; D015233:Models, Statistical; D012189:Retrospective Studies; D018570:Risk Assessment