Validation of Bleeding Classifications in Coronary Artery Bypass Grafting

TY - JOUR

T1 - Validation of Bleeding Classifications in Coronary Artery Bypass Grafting

AU - Brascia, Debora

AU - Reichart, Daniel

AU - Onorati, Francesco

AU - Perrotti, Andrea

AU - Ruggieri, Vito G

AU - Bounader, Karl

AU - Verhoye, Jean Philippe

AU - Santarpino, Giuseppe

AU - Fischlein, Theodor

AU - Maselli, Daniele

AU - Dominici, Carmelo

AU - Mariscalco, Giovanni

AU - Gherli, Riccardo

AU - Rubino, Antonino S

AU - De Feo, Marisa

AU - Bancone, Ciro

AU - Gatti, Giuseppe

AU - Santini, Francesco

AU - Dalén, Magnus

AU - Saccocci, Matteo

AU - Faggian, Giuseppe

AU - Tauriainen, Tuomas

AU - Kinnunen, Eeva-Maija

AU - Nicolini, Francesco

AU - Gherli, Tiziano

AU - Rosato, Stefano

AU - Biancari, Fausto

N1 - Copyright © 2016 Elsevier Inc. All rights reserved.

PY - 2017/3/1

Y1 - 2017/3/1

N2 - 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.

AB - 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.

KW - Acute Kidney Injury/epidemiology

KW - Aged

KW - Anticoagulants/therapeutic use

KW - Coronary Artery Bypass/methods

KW - Coronary Stenosis/surgery

KW - Female

KW - Hemorrhage/classification

KW - Humans

KW - Intraoperative Complications/classification

KW - Logistic Models

KW - Male

KW - Mammary Arteries/transplantation

KW - Middle Aged

KW - Multivariate Analysis

KW - Platelet Aggregation Inhibitors/therapeutic use

KW - Postoperative Hemorrhage/classification

KW - Prospective Studies

KW - ROC Curve

KW - Registries

KW - Risk Factors

KW - Severity of Illness Index

KW - Stroke/epidemiology

U2 - 10.1016/j.amjcard.2016.11.027

DO - 10.1016/j.amjcard.2016.11.027

M3 - SCORING: Journal article

C2 - 28024656

VL - 119

SP - 727

EP - 733

JO - AM J CARDIOL

JF - AM J CARDIOL

SN - 0002-9149

IS - 5

ER -