Validation of Bleeding Classifications in Coronary Artery Bypass Grafting - 18/04/17

Doi : 10.1016/j.amjcard.2016.11.027

Debora Brascia, MD ^a, Daniel Reichart, MD ^b, Francesco Onorati, MD, PhD ^c, Andrea Perrotti, MD ^d, Vito G. Ruggieri, MD, PhD ^e, Karl Bounader, MD ^e, Jean Philippe Verhoye, MD ^e, Giuseppe Santarpino, MD, PhD ^f, Theodor Fischlein, MD, PhD ^f, Daniele Maselli, MD ^g, Carmelo Dominici, MD ^g, Giovanni Mariscalco, MD, PhD ^h, Riccardo Gherli, MD ⁱ, Antonino S. Rubino, MD, PhD ^j, Marisa De Feo, MD, PhD ^k, Ciro Bancone, MD ^k, Giuseppe Gatti, MD ^l, Francesco Santini, MD ^m, Magnus Dalén, MD, PhD ⁿ, Matteo Saccocci, MD ^o, Giuseppe Faggian, MD ^c, Tuomas Tauriainen, MS ^a, Eeva-Maija Kinnunen, MD, PhD ^a, Francesco Nicolini, MD, PhD ^p, Tiziano Gherli, MD ^p, Stefano Rosato, MSc ^q, Fausto Biancari, MD, PhD ^a,^⁎
^a Department of Surgery, Oulu University Hospital, Oulu, Finland
^b Hamburg University Heart Center, Hamburg, Germany
^c Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy
^d Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
^e Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
^f Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
^g Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy
^h Department of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester, United Kingdom
ⁱ Unit of Cardiac Surgery, Department of Cardiosciences, Hospital S. Camillo-Forlanini, Rome, Italy
^j Centro Cuore Morgagni, Pedara, Italy
^k Division of Cardiac Surgery, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
^l Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
^m Division of Cardiac Surgery, University of Genoa, Genoa, Italy
ⁿ Department of Molecular Medicine and Surgery, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
^o Department of Cardiac Surgery, Centro Cardiologico-Fondazione Monzino IRCCS, University of Milan, Milan, Italy
^p Division of Cardiac Surgery, University of Parma, Parma, Italy
^q National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanitá, Rome, Italy

^∗Corresponding author: Tel: (+358) 40-7333-973; fax: (+358) 8-315-2486.

Abstract

Perioperative bleeding is a determinant of poor outcome in patients undergoing coronary artery bypass grafting (CABG), but there is a lack of adequate stratification of its severity. The ability of the European registry of Coronary Artery Bypass Grafting (E-CABG), Universal Definition of Perioperative Bleeding (UDPB), Study of Platelet Inhibition and Patient Outcomes (PLATO), Clopidogrel and Aspirin Optimal Dose Usage to Reduce Recurrent Events−Seventh Organization to Assess Strategies in Ischemic Syndromes (CURRENT-OASIS 7), Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q Wave Coronary Events (ESSENCE), and SafeTy and Efficacy of Enoxaparin in Percutaneous coronary intervention patients, an internationaL randomized Evaluation (STEEPLE) bleeding classifications to predict early mortality, stroke, acute kidney injury (AKI) stage 3, and deep sternal wound infection/mediastinitis was investigated in 3,730 patients from the prospective, multicentre E-CABG registry. Increasing grades of the E-CABG, UDPB, PLATO, and CURRENT-OASIS 7 classifications were associated with increasing risks of early mortality, had similar receiver-operating characteristic area under the curves (>0.7), and were predictive also when adjusted for EuroSCORE II. The E-CABG and UDPB classifications had satisfactory area under the curves (>0.6) in predicting stroke, AKI stage 3, and deep sternal wound infection/mediastinitis even when adjusted for EuroSCORE II. The PLATO and CURRENT-OASIS 7 classifications had similar predictive ability for stroke and AKI stage 3 as confirmed by multivariate analysis adjusted for EuroSCORE II but showed inferior ability in predicting severe wound infection compared to the E-CABG and UDPB classifications. The STEEPLE and ESSENCE classifications had a poor ability of predicting all these adverse events. Decision curve analysis showed a benefit of the E-CABG bleeding classification over the other classifications in predicting all adverse events. In conclusion, the E-CABG, UDPB, PLATO, and CURRENT-OASIS 7 bleeding classifications have a satisfactory ability in predicting adverse events after CABG. Decision curve analysis showed that the E-CABG bleeding classification had the best predictive performance.

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	Clinical Trial Registration: NCT02319083 (NCT02319083).
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Vol 119 - N° 5

P. 727-733 - mars 2017 Retour au numéro

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Validation of Bleeding Classifications in Coronary Artery Bypass Grafting - 18/04/17

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