Coronary artery bypass surgery prognosis
Coronary Artery Bypass Surgery Microchapters
Coronary artery bypass surgery prognosis On the Web
Prognosis following Coronary artery bypass surgery (CABG) depends on a variety of factors. In general, CABG improves the chances of survival of patients who are at high risks, such as those patients with the left main disease. After approximately 5 years the difference in survival rate between those who have had surgery and those treated by medication therapy diminishes. Age at the time of CABG is critical to the prognosis, therefore younger patients with no complicating diseases have a high probability of greater longevity. Recommended by ACC 2021 guideline, STS score system can be used to predict adverse outcomes of CABG such as death, renal failure, prolonged hospital stay, and mediastinitis.
- Age at the time of CABG is critical factor to determine the prognosis. Younger patients with no complicating diseases have a high probability of greater longevity.
- In a cohort study of 1,388 patients who were 48.9 years in average at the time of their first surgery survival rate were as follows:
- 5 years: 93.6%
- 10 years: 81.1%
- 15 years: 62.1%
- 20 years: 46.7%
- 23 years: 38.4%
Society of Thoracic Surgery (STS) Risk Score
- Based on ACC 2021 revascularization guideline, STS risk score is recommended to predict the prognosis of CABG.
- This score system can predict the adverse outcomes of CABG such as death, permanent stroke, renal failure, repeated surgery, deep sternal wound infection, prolonged mechanical ventilation, and hospitalization.
- Compared to EuroSCORE II (the European System for Cardiac Operative Risk Evaluation), STS risk score is more accurate in predicting CABG outcomes, especially at mortality rates higher than 5%.
- STS risk score is limited in evaluating the effect of conditions such as cirrhosis, malnutrition, and frailty on CABG's outcome. Therefore, for patients who are candidates for CABG and have those conditions other tools should be used.
- STS risk score is derived from the United States' data on patients who had CABG. The following table shows last updated STS risk score (2018) for patients who had only CABG or CABG with a heart value surgery.
|Adverse Outcomes||CABG||CABG and heart value surgery|
|Prolonged mechanical ventilation||0.772||0.744|
|Composite morbidity and mortality||0.738||0.712|
|Prolonged post operation hospitalization||0.777||0.739|
|Deep sternal wound infection/Mediastinitis||0.681||0.659|
2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)
Public Reporting of Cardiac Surgery Outcomes (DO NOT EDIT)
|"1. Public reporting of cardiac surgery outcomes should use risk-adjusted results based on clinical data. (Level of Evidence: B)"|
Use of Outcomes or Volume as CABG Quality Measures (DO NOT EDIT)
|"1. All cardiac surgery programs should participate in a state, regional, or national clinical data registry and should receive periodic reports of their risk-adjusted outcomes. (Level of Evidence: C)"|
|"1. When credible risk-adjusted outcomes data are not available, volume can be useful as a structural metric of CABG quality. (Level of Evidence: B)"|
|"1. Affiliation with a high-volume tertiary center might be considered by cardiac surgery programs that perform fewer than 125 CABG procedures annually. (Level of Evidence: C)"|
- Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM; et al. (2022). "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". J Am Coll Cardiol. 79 (2): e21–e129. doi:10.1016/j.jacc.2021.09.006. PMID 34895950 Check
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