Main Organiser

Julius Centre University of Malaya

Co-organiser

Department of Social and Preventive Medicine, Faculty of Medicine, University of Malay

Supported by

University of Malaya

IMPACT OF PROOPERATIVE FACTORS ON MORTALITY FOLLOWING CABG WITH RENAL DYSFUNCTION

Author

Sumanta, Mohsina

Institution

Monash University

Abstract

Objectives: To analyze preoperative risk factors for early mortality (30-day, died within 30 days of surgery) following isolated coronary artery bypass grafting (CABG) patients with renal dysfunction (GFR less than 60mL/min/173m2 or on dialysis).

Methods: Data was collected between 2001 and 2010 from 20 hospitals in Australia. Logistic regression and stepwise variable selection were used to identify pre-operative risk factors for 30- day mortality. ROC and H-L were used to evaluate model’s efficiency.

Results: Of the 21295 CABG patients 5897 (27.7%) had GFR less than 60mL/min/173m2 or dialysis. The cohort was more likely to be octogenarian (21.6% vs 2.4%, p<0.001), had poorer ejection fraction estimate (less than 30%: 7.0% vs 3.7%, p< 0.001) and NYHA classification (class III or IV: 28.8% vs 19.8%, p<0.001) and more often with 30-day mortality (3.1% vs 1.0%) and previous MI (59.2% vs 51.7%, p< 0.001)). Independent factors for 30-day mortality: age (70-79yrs, OR: 1.9, p=0.004; above 79yrs, OR: 2.6, p<0.001), gender (OR: 0.66, p=0.012), ejection fraction estimate (30%-45%, OR: 1.8, p=0.003; <30%, OR: 4.2, p<0.001), medication inotropes (OR: 3.3, p<0.001), emergency/salvage procedures (OR: 2.1, p=0.002), NYHA class III/IV (OR: 2.2, p<0.001), previous MI (OR: 2.3, p<0.001) and hypercholesterolemia (OR: 0.68, p=0.029). The discrimination (ROC = 78.2%) and calibration (H-L p-value = 27.0%) of the model were very good.

Conclusion: Pre-operative risk factors for 30-day mortality following isolated CABG patients with renal dysfunction were investigated. This finding would be useful when assessing patients’ clinical risk of mortality following isolated CABG patients.