Opcab vs Midcab in Octogenarians with Single-vessel Coronary Artery Disease (from The Krok Registry)
Grzegorz Hirnle1, Piotr Knapik1, Krzysztof Filipiak2, Tomasz Hrapkowicz1, Marek Cisowski1, Rafal Pawlaczyk3, Bartlomiej Perek4, Michal Zembala1
1Silesian Center for Heart Diseases, Zabrze, Poland, 2Pomeranian Medical University, Department of Cardiac Surgery, Szczecin, Poland, 3University Clinical Center, Department of Cardiac Surgery, Gdansk, Poland, 4Medical University of Poznan, Department of Cardiac Surgery and Transplantology, Poznan, Poland
Background: Octogenarians are the fastest growing part of the contemporary cardiac surgical population, however accuraterisk stratification in this group remains uncertain. We aimed to assess the reliability of EuroSCORE II in octogenarians undergoing isolated coronary artery surgery, and create a formula adjusting the original score, if it proves necessary. Methods: All octogenarians who underwent isolated coronary surgery in Poland between January 2012 and December 2018, enrolled in the Polish National Registry of Cardiac Surgical Procedures (KROK Registry), were retrospectively analyzed. EuroSCORE II reliability was estimated by the area under the ROC curve and the observed to predicted mortality ratio, separately for patients operated on-pump and off-pump. The original score was adjusted by creation of a nomogram to obtain an optimal predictive power. Results: Among 4328 octogenarians, 2026 (46.8%) were operated on-pump and 2302 (53.2%) were operated off-pump. EuroSCORE II was accurate in patients operated off-pump (AUC: 0.71, O/E ratio: 1.0) and underestimated mortality in patients operated on-pump (AUC: 0.72, O/E ratio 1.55). The worst performance of the EuroSCORE II was noted among patients with the lowest predicted mortality (0.50%-1.82%). Adding a coefficient and creating a nomogram accurate calibration was obtained. Conclusions: EuroSCORE II was reliable in a Polish population undergoing isolated coronary surgery. Following on-pump surgery, the observed mortality was much higher than expected, but was made accurate by adding a coefficient to the initially calculated EuroSCORE II.