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CARDIOVASCULAR ANESTHESIA

Predicting the Risk of Death from Heart Failure After Coronary Artery Bypass Graft Surgery

Stephen D. Surgenor, MD, MS^*, Gerald T. O’Connor, PhD, DSc, Stephen J. Lahey, MD^§, Reed Quinn, MD^||, David C. Charlesworth, MD^¶, Lawrence J. Dacey, MD, MS, Robert A. Clough, MD^#, Bruce J. Leavitt, MD^**, Gordon R. Defoe, CCP, Mary Fillinger, MD^*, William C. Nugent, MD, and for the Northern New England Cardiovascular Disease Study Group

Departments of *Anesthesiology, Community and Family Medicine, and Surgery, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; §Department of Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts; ||Department of Surgery, Maine Medical Center, Portland, Maine; ¶Department of Surgery, Catholic Medical Center, Manchester, New Hampshire; #Department of Surgery, Eastern Maine Medical Center, Bangor, Maine; **Department of Surgery, Fletcher-Allen Health Center, Burlington, Vermont

Address correspondence to Stephen D. Surgenor, MD, Department of Anesthesiology, One Medical Center Drive, Lebanon, NH 03756. Address e-mail to stephen.d.surgeonor{at}hitchcock.org

Heart failure is the most common cause of death among coronary artery bypass graft (CABG) patients. In addition, most variation in observed mortality rates for CABG surgery is explained by fatal heart failure. The purpose of this study was to develop a clinical risk assessment tool so that clinicians can rapidly and easily assess the risk of fatal heart failure while caring for individual patients. Using prospective data for 8,641 CABG patients, we used logistic regression analysis to predict the risk of fatal heart failure. In multivariate analysis, female sex, prior CABG surgery, ejection fraction <40%, urgent or emergency surgery, advanced age (70–79 yr and >80 yr), peripheral vascular disease, diabetes, dialysis-dependent renal failure and three-vessel coronary disease were significant predictors of fatal postoperative heart failure. A clinical risk assessment tool was developed from this logistic regression model, which had good discriminating characteristics (receiver operating characteristic clinical source = 0.75, 95% confidence interval: 0.71, 0.78).

Implications: In contrast to previous cardiac surgical scoring systems that predicted total mortality, we developed a clinical risk assessment tool that evaluates risk of fatal heart failure. This distinction is relevant for quality improvement initiatives, because most of the variation in CABG mortality rates is explained by postoperative heart failure.

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