title: Identification of patients at risk for early out-of-hospital mortality after redocoronary artery surgery.
abstract: OBJECTIVE
  Analyse risk factors and construct a predictive model for identification of patients at risk of early out-of-hospital mortality after coronary reoperations (RECABG).
  
  
  METHODS
  505 patients, discharged from hospital after a RECABG (1987-1998), were studied by univariate and multivariate analysis. A stepwise selective procedure (p<0.05) was used to identify a subset of variables with prognostic value for early out-of-hospital mortality. This subset was used to calculate a prognostic score 'S' and a predicted probability 'p' for early out-of-hospital mortality, p=1/1+ e-s. Sensitivity analysis was used for evaluation.
  
  
  RESULTS
  The best predictive variables for early out-of-hospital mortality were diabetes (p=0.002), lung disease (p=0.05), emergency operation (p=0.0001) and a perioperative myocardial infarction (p=0.0001). Emergency operation (p=0.001) and antegrade/retrograde cardioplegia (p<0.0000) were independent predictors of a perioperative myocardial infarction. The prognostic accuracy (ROC area) was 86%. Patients were classified into low risk (5%), intermediate risk (15%), high risk (30%) and very high risk (≥40%). A predicted probability of ≥0.40 was used as cut-off point. The specificity of this test was 99%, sensitivity 33%, predictive value of a positive test 79%, and 95% for a negative test.
  
  
  CONCLUSIONS
  The results show that patients discharged from hospital after RECABG can be stratified according to their early out-of-hospital risk. A perioperative myocardial infarction is the major independent risk factor and can be affected by use of retrograde cardioplegia.
authors.forename: F M
authors.initials: FM
authors.lastname: van Eck
authors.forename: L
authors.initials: L
authors.lastname: Noyez
authors.forename: F W A
authors.initials: FW
authors.lastname: Verheugt
authors.forename: R M H J
authors.initials: RM
authors.lastname: Brouwer
keywords: coronary reoperation; mortality; out-of-hospital; prediction