Abstract 3042: Bedside Tool For Predicting Operative Mortality In Patients With Cardiogenic Shock Undergoing Coronary Artery Bypass Surgery
Background: Patients (pts) with cardiogenic shock (CS) often require coronary artery bypass surgery (CABG) and are a high-risk cohort. Rapid, accurate estimation of an individual pt’s risk for operative mortaliy is needed for clinical decision making and counseling.
Methods: We analyzed data of 12339 pts with CS from Society of Thoracic Surgeons database undergoing urgent, emergent or emergent salvage CABG (2002–2005). Logistic regression was used to identify major predictors of operative mortality. The full model was then simplified, with model coefficients converted to an additive risk score.
Results: Operative mortality occurred in 2643 pts with CS after CABG (21.4%). Independent preoperative risk factors associated with increased risk of death included surgery type (highest for CABG+ventricular septal rupture, lowest for isolated CABG and in between for CABG+mitral or aortic valve), age, preoperative creatinine, surgery status (salvage vs. other), ejection fraction, female, intraaortic balloon pump, prior cardiac surgery, preoperative resuscitation, MI <7 days before CABG, and immunosuppressive use (c-index 0.74). Bootstrap validation of the full model using 200 replicates showed good internal validation (c-index 0.74, 95% CI 0.74 – 0.74). Individual pt risk scores ranged from 0 to 86. The risk score was able to identify those with low, modest, and high risk for operative death (Figure⇓).
Conclusions: Our study identifies the major risk factors for operative mortality for pts with CS undergoing CABG. These have been converted into a simple, accurate bedside risk tool. This should faciliate improved clinician-pt discussions regarding risks of operative mortality.