Risk stratification in patients with coronary heart disease before cardiac surgery

Abstract

Objective. To analyse the risk stratification effectiveness for calculators EuroSCORE I, EuroSCORE II, STS in patients with ischemic disease before cardiac surgery. Materials and methods. Retrospective analysis of data was conducted from randomized 194 patients with coronary artery disease who were discharged from the Amosov National Institute of Cardiovascular Surgery after coronary artery bypass surgery in the period 2009 - 2019. An average age of patients was (64.2 ± 8.9). In all patients clinical and laboratory studies, echocardiography, electrocardiography, coronary angiography as well as surgical revascularization were conducted. Preoperative risk stratification was performed using three available calculators Euro SCORE I, EuroSCORE II and STS. Results. There was no mortality in the study group of patients, while the predicted surgical mortality on the EuroSCORE I scale was 25.02%, EuroSCORE II - 7.78%, STS - 2.84%. According to the results of twenty years period of the Amosov National Institute of Cardiovascular Surgery in the surgical treatment of coronary heart disease in more than 15,000 patients, mortality from coronary heart disease was less than 0.6%, which is much less than the predicted mortality rates. Conclusions. Prior to surgery, risk stratification of patients should be performed on appropriate scales to understand their baseline status. The EuroSCORE II scale is optimal for use in modern cardiac surgery. Surgery in patients with a high estimated risk (EuroSCORE II> 5%) should be performed by an experienced cardiac surgeon with more than 10 years of cardiac surgery experience.

Keywords

• risk scales; euroscore ii; coronary heart disease; patient category of high risk; comorbidity.