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Background: Despite the steady improvements in survival and operative safety, postoperative complications still remain a significant cause of morbidity and mortality after coronary artery bypass grafting (CABG). However, less is known on the impact of postoperative complications on health-related quality of life (QoL). The main objective of our study was to investigate the impact of postoperative complications on long-term QoL and survival after CABG surgery., Methods: Data of 508 patients, who underwent isolated CABG was prospectively collected. The RAND-36 Health Survey (RAND-36) was used to evaluate patients' QoL status preoperatively, 1 year and 12 years after the surgery. Predefined postoperative complications were reported during primary and secondary hospital stay. QoL and survival analysis were performed primarily on three patient groups: patients with and without complications and patients with major adverse cardiac and cerebrovascular events (MACCE)., Results: In total 205(40%) of 508 patients had at least one postoperative complication and 73 (14%) experienced MACCE. Patients' thirty-day, 1-year and 10-year survival rates were, 99, 98, 84% without complications, 97, 95, 72% with complications, and 90, 89, 64% with MACCE, respectively (log-rank p < 0.001). Patients without complications showed significant(p < 0.05) improvements in seven and patients with complications in five out of eight RAND-36 QoL dimensions. All patient groups showed significant improvements in RAND-36 summary scores compared with preoperative values. Patients with complications and especially with MACCE had more profound decline in their RAND-36 summary scores while patients without complications maintained their health status best., Conclusions: Despite the constant deterioration, both patients with and without complications showed improvements even 12 years after CABG compared with preoperative state. Postoperative complications and especially MACCE were associated with impaired long-term QoL.

Objective: The proportion of obese patients undergoing coronary artery bypass graft (CABG) surgery is increasing. In this study, our main objective was to assess the effect of obesity on long-term mortality and changes in quality of life (QoL) after GABG., Materials and Methods: Data of 508 patients who underwent isolated GABG were prospectively collected. RAND-36 Health Survey (RAND-36) was used as an indicator of QoL. BMI was used to assess obesity, and the analysis was based primarily on two patient groups: BMI less than 30 kg/m (408 patients) and BMI of at least 30 (100 patients). All assessments were made preoperatively and repeated 1 and 12 years after CABG surgery. The follow-up of the cohort was complete in 95 and 84% of the alive patients at 1 and 12 years, respectively., Results: Thirty-day, 1-year, and 10-year survival rates were 99.0, 97.0, and 78.0%, respectively, in the obese and 98.0, 96.8, and 79.2%, respectively, in the nonobese group. Obese showed significant (P<0.05) improvements only in four and nonobese in seven of eight RAND-36 dimensions of QoL. In both obese and nonobese patients, improved RAND-36 physical component summary and mental component summary scores were seen in comparison with the preoperative values. Yet, obese patients had a more pronounced diminution in their physical component summary and mental component summary scores, whereas nonobese patients maintained their physical and mental health status better., Conclusion: Despite an on-going decline in 12 years after the CABG, both patient groups showed improvements in their health status in comparison with preoperative values. Obese patients gained less benefit in terms of QoL dimension, but there was no significant difference in overall mortality in the long-term follow-up.

Objectives: To evaluate the long-term effect of perioperative myocardial infarction (PMI) on outcomes and health-related quality-of-life (QOL) after coronary artery bypass grafting (CABG)., Methods: Eighty of the 501 patients (16%) fulfilled electrocardiogram or cardiac enzyme criteria for PMI and were compared with patients with no PMI. The RAND-36 Health Survey was used as an indicator of QOL. Assessments were made preoperatively and repeated 1 year and 12 years later., Results: Thirty-day mortality was adversely affected by PMI (6.3 vs 1.0%, P = 0.001). One-year survival rates for PMI and no-PMI patients were 92.5 and 97.6%, 10-year rates being 72.5 and 79.8%. One year after the surgery, PMI patients improved in seven and no-PMI patients in all the eight RAND-36 dimensions. In the 12-year follow-up, the scores showed a general decline tendency. PMI patients still maintained a significant improvement in four and no-PMI patients in seven of eight dimensions when compared with the baseline scores. A highly significant improvement was seen in the RAND-36 mental and physical component summary scores in the no-PMI group 1 year after CABG. PMI patients improved also significantly although the magnitude of change was lower. In the 12-year follow-up, there was a general decline tendency in the scores. Both groups showed similar freedom from anginal symptoms at 12 years., Conclusions: Although PMI has a negative impact on health-related QOL 1 year after CABG, this effect is only minor in the long term. PMI increases 30-day mortality but shows no effect on later mortality.

Objectives: Improvement in quality of life (QoL) and survival benefit are the primary objectives of coronary artery bypass graft (CABG) surgery. The profile of patients undergoing isolated CABG has altered towards higher age with more preoperative comorbidities. Thus, the importance of QoL over the quantity of life among elderly patients is getting more emphasized. In this study, our main goal was to evaluate the long-term changes in QoL, overall performance status and symptomatic status after the CABG., Methods: Comprehensive data of 508 patients who underwent isolated CABG in a single institution were prospectively collected. The RAND-36 Health Survey (RAND-36) was used as an indicator of QoL. Karnofsky dependency category was used to evaluate overall performance status, and symptomatic status was assessed using New York Heart Association (NYHA) class. All assessment were made preoperatively and repeated 1 year and 12 years later. The follow-up of the study cohort was complete in 95 and 84% of the alive patients at 1 year and 12 years, respectively. Analysis was based mainly on three age groups: ≤64 years (282 patients), 65-74 years (175 patients) and ≥75 years (51 patients)., Results: Thirty-day, 1-year and 10-year survival rates were 98, 97 and 79%, respectively. Twelve years after the surgery significant improvement (P<0.05) was seen in all but one RAND-36 dimensions of the QoL (general health, P=0.76) as well as in functional capacity (P<0.001) and NYHA class. All age groups showed improvements in RAND-36 physical component summary (PCS) and mental component summary (MCS) scores compared with the preoperative values. The youngest subgroup maintained their physical and mental health status best, whereas older subgroups had more pronounced decreases in their PCS and MCS scores., Conclusions: Despite an ongoing deterioration 12 years after the CABG, there was significant improvement in most dimensions of the QoL and functional capacity in comparison with the preoperative values. The elderly gain less long-term benefit from CABG regarding the QoL and survival.

Objective: To assess whether the use of either the on-pump or the off-pump method affects changes in health-related quality of life (QOL) in the long term after coronary artery bypass graft (CABG) surgery., Methods: Four hundred and fifty-two (89.0%) of the 508 patients in a single institution were operated on-pump and 56 (11.0%) were operated off-pump. The RAND-36 Health Survey (RAND-36) was used as an indicator of QOL. Assessments were performed preoperatively and repeated 1 year and 12 years later. Symptomatic status was estimated according to New York Heart Association class., Results: After 1 year, on-pump patients improved significantly (P<0.001) in all eight RAND-36 dimensions. Also, in off-pump patients, positive changes were observed in all RAND-36 dimensions and these changes were statistically significant (P<0.05) in six dimensions. Despite an ongoing decrease in QOL over the 12-year follow-up, on-pump patients still maintained a significant (P<0.05) improvement in all and off-pump patients in seven out of eight RAND-36 dimensions. A highly significant (P<0.001) pattern of change after 1 year was observed in the RAND-36 Mental Component Summary and Physical Component Summary scores in both operative groups, and despite the general declining trend, significant improvement was maintained during the 12-year follow-up time. Both groups showed almost identical relief from anginal symptoms at 12 years., Conclusion: A majority of patients experience significant improvement in health-related QOL in the long term after CABG. Cardiopulmonary bypass has no impact on patients' subsequent health-related QOL.

Background: Widespread ST-segment depression with inverted T waves maximally in leads V4-V5 (ie, the global ischemia electrocardiogram [ECG] pattern) is a marker of adverse outcome in patients with non-ST-segment elevation acute coronary syndrome (ACS), perhaps because this pattern is indicative of left main stem stenosis. However, the prognostic value of this ECG pattern has not yet been established., Objective: We studied the predictive value of a prespecified ECG pattern in patients who underwent urgent or emergent coronary artery bypass grafting (CABG)., Methods: We studied the sensitivity, specificity, and predictive values for the global ischemia ECG to predict angiographic left main coronary artery disease. Patients with a 12-lead ECG recorded during anginal symptoms before CABG were included., Results: The global ischemia ECG pattern was found in 61 (76%) of 80 patients with and 12 (19%) of 65 patients without left main disease. The sensitivity, specificity, and positive and negative predictive values for left main coronary artery disease in patients with the global ischemia ECG pattern were 76%, 81%, 84%, and 74%, respectively. In multivariate analysis, the global ischemia ECG pattern was strongly associated with angiographic left main coronary artery disease after adjusting for age, gender, diabetes, hypertension, and smoking (hazard ratio, 16.0; 95% confidence interval, 6.5-39.5; P < 0.001)., Conclusion: The global ischemia ECG pattern was strongly associated with angiographic left main coronary artery disease in patients who underwent urgent or emergent CABG.

Objective: Ischemic preconditioning reduces infarct size and improves hemodynamic function. Unstable angina may be a clinical analogue to ischemic preconditioning, and involve activation of gene programs. We hypothesized that preceding unstable angina and/or ischemic preconditioning activated genes regulated by nuclear factor kappa B (NFkappaB) or hypoxia-inducible factor 1 alpha in parallel to improved cardiac function., Methods: Patients undergoing coronary artery bypass grafting with stable or unstable angina were subjected to ischemic preconditioning or sham treatment (n=10-11 in each group). Central hemodynamics were monitored. Left ventricular and atrial biopsies were harvested before cardioplegic arrest and after 25 min of reperfusion. Expression of heat shock protein 72 was evaluated by immunoblot, and activation of NFkappaB was detected by electrophoretic mobility shift assay. Real-time PCR was used to quantify expression of genes regulated by NFkappaB (inducible nitric oxide synthase, tumor necrosis factor-alpha, intercellular adhesion molecule 1) or by hypoxia-inducible factor 1 alpha (heme oxygenase-1, glucose transporter-1 and vascular endothelial growth factor-A)., Results: Ischemic preconditioning improved postoperative cardiac index and left ventricular stroke work index in both stable and unstable groups on the first postoperative day. Expression of hypoxia-inducible factor 1 alpha regulated genes was not influenced by cardioplegia and reperfusion, ischemic preconditioning or unstable angina. Expression of the NFkappaB-regulated genes increased after cardioplegia and reperfusion, but this was not influenced by ischemic preconditioning in stable patients. Inducible nitric oxide synthase and tumor necrosis factor expression were reduced after ischemic preconditioning in patients with unstable angina. There were no significant differences in gene expression between stable and unstable patients before cardioplegia and ischemic preconditioning. NFkappaB translocation at reperfusion was reduced in stable preconditioned and unstable control patients compared to stable controls. Heat shock protein 72 expression increased after preconditioning of unstable patients., Conclusion: Cardiac function was improved by ischemic preconditioning in both stable and unstable patients. Unstable angina per se had no effect. NFkappaB-regulated genes were influenced by ischemic preconditioning, but hypoxia-inducible genes were not.

Objective: Apoptosis has been considered as one of the mechanisms of cardiomyocyte loss during open heart surgery. Adenosine is cardioprotective against ischemia-reperfusion injury in experimental models. The aim of this study was to find out whether the administration of single dose adenosine added to blood cardioplegia is effective in decreasing the apoptosis process., Methods: In a double-blinded randomized control intervention study, 40 patients were enrolled for elective coronary artery bypass grafting. In the adenosine group (n=20) patients received 250 microg/kg adenosine in the aortic root after cross-clamping followed by cold blood cardioplegia. In the control group (n=20) patients had only antegrade cardioplegia. Left ventricular tissue samples (from apex) were taken before and after the bypass. The apoptotic cells were identified by dUTP nick-end labeling (TUNEL) using an apoptosis detection kit. The number of TUNEL-positive cardiomyocytes was expressed as percentage of the total number of cardiomyocytes in histological tissue sections., Results: The groups were closely identical in demographic data, cross-clamp time, cardiopulmonary bypass time and weaning time. The postoperative cardiac index and other hemodynamic parameters, including the patterns of CK-MB, did not show statistically significant differences. In the tissue samples there were an equal number of patients who developed apoptosis after the cross-clamp. Although the frequency of apoptosis in the control group was two times higher than in the adenosine group, this was statistically not significant., Conclusions: Adenosine enhanced blood cardioplegia could not prevent myocardial apoptosis completely. However, it seems to be that adenosine might influence the frequency of apoptosis and this needs to be considered in future investigations.

Background: An increasing proportion of patients undergoing coronary artery bypass grafting (CABG) are obese and are thought to carry a higher mortality and morbidity in association with surgery, but data on whether health-related quality of life (QOL) improves similarly after CABG in obese and non-obese patients are limited. We assessed in detail the effect of obesity on changes in health-related QOL (RAND-36 Health Survey) during the first year following CABG., Methods: Comprehensive data on 508 CABG patients were prospectively collected. One hundred patients (19.7%) were categorized as obese (body mass index >or= 30 kg/m(2)). The RAND-36 Health Survey was used as an indicator of quality of life. Assessments were made preoperatively and repeated 12 months later., Results: The obese group fared significantly worse than the non-obese group with regard to the likelihood of superficial wound infection (19.0% versus 7.1%, P < 0.001), impaired renal function (31.7% versus 14.4%, P = 0.01), and required on average 2 days longer in hospital (P < 0.05). The incidence of mediastinitis was not significantly higher among the obese patients (2.0% versus 1.2%, P = 0.55), and they less frequently needed postoperative red cell transfusions (29.0% versus 44.9%, P = 0.004). The obese improved significantly (P < 0.001) in 7, and the non-obese (P < 0.001) in all 8 RAND-36 dimensions. Physical Component Summary and Mental Component Summary scores on the RAND-36 improved significantly (P < 0.001) in obese as well as in non-obese patients., Conclusions: Although obese patients differ from non-obese patients in that they had inferior QOL before and in the year following CABG, they gain a similar improvement in QOL 1 year after surgery compared with non-obese patients. Excluding superficial wound infection, transient impaired renal function, and slightly longer hospital stay, obesity does not significantly increase the risk of other adverse outcomes during the first year following CABG.

Background: An increasing proportion of patients undergoing coronary artery bypass grafting are diabetics who are known to carry a higher mortality and morbidity in association with operation, but data on whether health-related quality of life improves similarly after coronary artery bypass grafting in diabetic and nondiabetic patients are limited. We assessed in detail changes in health-related quality of life (RAND-36 Health Survey) during the first year after coronary artery bypass grafting., Methods: Seventy-four of the 508 patients (14.6%) operated on in a single institution had a history of diabetes and were compared to nondiabetics. The RAND-36 Health Survey was used as an indicator of quality of life. Assessments were made preoperatively and repeated 12 months later., Results: Thirty-day mortality was 2.7% versus 1.6% (p = 0.511) and one-year survival was 94.6% versus 97.0% (p = 0.287) in the diabetics and nondiabetics, respectively. Diabetics improved significantly (p < 0.005) in seven, nondiabetics (p < 0.001) in all eight RAND-36 dimensions. Physical component summary and mental component summary scores on the RAND-36 improved significantly (p < 0.001) in diabetics as well as in nondiabetics. Both groups experienced closely similar freedom from anginal symptoms at one year (86.2% vs 90.5%, p = 0.280)., Conclusions: Although diabetic patients differ from nondiabetics having slightly inferior quality of life before and one year after coronary artery bypass grafting, they gain similar improvement of quality of life in one year after surgery when compared to nondiabetics.

Objective: To investigate whether administration of isoflurane prior to cardiopulmonary bypass (CPB) could partly account for the observed protection of the myocardial function and to decrease myocardial injury in patients undergoing coronary artery bypass grafting (CABG)., Methods: Thirty-four patients with stable angina who were scheduled for isolated elective CABG operations were randomized into the control group or isoflurane (ISO) group. In the ISO group, isoflurane was inhaled for 5 min followed by another 5-min washout period before commencing CPB. The control group did not receive isoflurane. Hemodynamic data and biochemical markers of myocardial injury were measured perioperatively., Results: There were no adverse effects related to isoflurane. Cardiac index (CI) increased postoperatively as compared with the baseline. In the ISO group, there was a tendency for a greater increase of CI than that in the control group (p = 0.054, ANOVA for repeated measurements). At 1 h after CPB, the change of CI was much higher in the ISO group than that in the controls (p = 0.001). Both the creatine kinase cardiac isoenzyme (CK-MB) and troponin I (TnI) reached peak value at 6 h after CPB. Isoflurane patients released slightly less CK-MB than the controls postoperatively, but the difference was not significant (p = 0.16, ANOVA for repeated measurements). The release of TnI was similar in both groups (p = 0.65, ANOVA for repeated measurements)., Conclusions: Administration of isoflurane prior to commencing CPB may bring an improvement in early hemodynamic performance after CABG operations.

This prospective study was instituted to assess whether the use of the on-pump method or the off-pump method affects changes in health-related quality of life (QOL) as evaluated a year after coronary artery bypass graft (CABG) surgery. Data including preoperative risk factors and postoperative morbidity up to discharge were collected from 508 CABG patients operated in the Heart Center of a university hospital and further treated in secondary referral hospitals. Four hundred and fifty-two (89.0%) patients underwent operation with the on-pump method and 56 (11.0%) with the off-pump method, i.e., without cardiopulmonary bypass (CPB). The RAND-36 Health Survey (RAND-36) was used as indicator of QOL. The primary outcome measure was a change in the physical component summary (PCS) and mental component summary (MCS) from the RAND-36. Symptomatic status was estimated according to New York Heart Association (NYHA) class. Assessments were made preoperatively and repeated 12 months later. The majority of patients operated on-pump (85.6%) and off-pump (92.9%) had a favorable outcome without major complications (p = 0.136). The present data showed significant improvement (p < 0.001) in all eight domains of QOL following on-pump CABG. Likewise, off-pump patients improved in all eight aspects, and the change was statistically significant in six dimensions. A highly significant (p < 0.001) pattern of change was seen in the RAND-36 MCS and PCS scores in both operative groups. Differences between the groups were nonsignificant. We conclude that most patients experience significant improvement in health-related QOL during the first year after CABG, and that cardiopulmonary bypass has no effect on patients' subsequent health-related QOL, but its use depends on specific indications.

Objective: Perioperative myocardial infarction (PMI) is a well-described complication of coronary artery bypass grafting (CABG). Data on its effect on patients' subsequent health-related quality of life (QOL) and on other related consequences is deficient. The aim here was to evaluate in a prospective follow-up design the risk factors for and consequences of PMI and especially its possible impact on health-related QOL., Methods: Comprehensive data, including preoperative risk profile, perioperative variables and postoperative morbidity up to discharge were collected of 501 CABG patients in the Heart Center of Tampere University Hospital and in all eighteen postoperative care hospitals. Eighty patients (16%) fulfilled ECG or cardiac enzyme criteria for PMI and they were compared to patients with no PMI. The RAND-36 Health Survey (RAND-36) was used as an indicator of QOL. The primary outcomes were change in physical component summary (PCS), mental component summary (MCS) and the eight dimensions of health-related QOL from the RAND-36. Symptomatic status was estimated according to New York Heart Association (NYHA) class. Assessments were made preoperatively and repeated 12 months later., Results: Multivariate logistic regression analysis identified long cardiopulmonary bypass time (P=0.006) and high age (P=0.049) as independent predictors for PMI. Thirty-day mortality was adversely affected by PMI (6.3 vs 1.0%, P=0.001). In discharged patients, the occurrence of PMI did not affect 1-year survival adversely (98.7 vs 98.6%). The PMI patients showed significant (P<0.05) improvements in six of the eight dimensions of RAND-36, but they presented with a negative change in their 'general health' scores at the follow-up. All QOL scores improved significantly (P<0.001) among the patients without PMI. A highly significant (P<0.001) pattern of change was seen in the RAND-36 PCS and MCS scores in both groups although PMI patients showed significantly (P=0.002) smaller change in their PCS scores. Both groups showed similar freedom from anginal symptoms at 1 year (89.6 vs 90.1%) but in the PMI group later readmissions due to cardiac-related causes were more common (23 vs 10%, P=0.002)., Conclusions: PMI increases 30-day mortality and affects also adversely on later health-related QOL following CABG.

Objective: To investigate whether novel pharmacological preconditioning with diazoxide could protect the myocardial function and decrease myocardial injury in patients undergoing coronary artery bypass grafting (CABG)., Methods: Forty patients with stable angina who were scheduled for isolated elective CABG operations were randomized into control group (n=20) and diazoxide (DZX) group (n=20). In the DZX group, 1.5 mg/kg diazoxide was infused intravenously within 5 min followed by a 5-min washout before commencing the cardiopulmonary bypass (CPB). In the control group, a time-matched period of placebo infusion was given. Hemodynamic data and biochemical markers of myocardial injury were measured perioperatively., Results: There were no adverse effects related to diazoxide. Cardiac index (CI) increased postoperatively as compared with baseline. In the DZX group, the improvement of CI was better than that in the control group (p=0.001). Left and right ventricular stroke work indexes decreased postoperatively, and recovered much faster in the DZX group (p=0.027 and p=0.049, respectively). There were no statistically significant differences in the other hemodynamic parameters. The creatine kinase cardiac isoenzyme (CK-MB) was highest in both groups on the first postoperative day (control 28.8+/-23.8 and DZX 27.3+/-19.4, N.S.). The cumulative release of CK-MB postoperatively was lower in the DZX patients as compared with the controls, but the difference remained not significant (p=0.09)., Conclusions: Pharmacological preconditioning of the human heart with diazoxide is feasible; it confers additional myocardial protection beyond that provided by the cardioplegia alone by attenuating myocardial stunning after CABG operations.

The present prospective clinical study was carried out to investigate the effect of age on mortality, morbidity, and readmission rates after coronary artery bypass grafting (CABG). Data on 1131 consecutive CABG patients were collected in a surgical center and in all 18 secondary referral hospitals up to 3 months after discharge. Analysis was based on three age groups: 64 years or less (510 patients), 65 to 74 years (448 patients), and 75 years or more (173 patients). Thirty-day mortality rates were 1.6% for the youngest, 5.4% for the middle age group, and 6.9% for the oldest. Major complications occurred in 10.8%, 21.2%, and 24.9% of these patients, respectively. Higher age was associated with more readmissions to health care facilities: The oldest patients had a rate twice as high as those in the youngest group (34.5% vs. 18.6%). Atrial fibrillation (15.4%), chest pain (10.6%), and congestive heart failure (8.5%) were the most common reasons for readmission. In conclusion, elderly patients, who are often suboptimal candidates for CABG, have higher 30-day mortality, higher morbidity, longer length of stay in health care facilities, and an increased risk of readmission within 3 months after CABG; age was an independent predictor of 30-day mortality and postdischarge readmission. Despite the higher risk of adverse events after surgery, three out of four elderly patients recover uneventfully.

Objective: Improvement in survival and quality of life are the primary indications for coronary artery bypass graft (CABG) operations. Among elderly patients the main goal of surgery is not necessarily to prolong life, but to improve the health-related quality of life. Factors associated with mortality and morbidity following CABG surgery have been well defined, but the quality of life and functional capacity in elderly patients undergoing CABG are poorly documented. The aim here was to investigate changes in health-related quality of life, overall performance status and symptomatic status during 1 year after CABG surgery., Methods: Comprehensive data on 508 CABG patients were prospectively collected, including preoperative risk factors and postoperative morbidity in a surgical center and in all eighteen secondary referral hospitals up to discharge. The RAND-36 Health Survey (RAND-36) was used as indicator of quality of life. The primary outcome was change in the physical component summary, mental component summary and General Health summary scores from the RAND-36. Karnofsky dependency category was used to assess overall performance status, and symptomatic status was estimated according to New York Heart Association (NYHA) class. All assessments were made preoperatively and repeated 12 months later. Analysis was based on three age groups: 64 years or less (282 patients), 65-74 years (175 patients), and 75 or more years (51 patients)., Results: Thirty-day and 1-year survival rates were 98.2 and 96.7%, respectively. A great majority (86.4%) of the patients recovered without major complication. In all, the present data showed significant improvement in all eight domains of QOL as well as in functional capacity and NYHA class during the 1st year after CABG. However, the mean change in RAND-36 Mental Component Summary scores among patients aged 75 years or more did not reach a statistically significant level (P=0.097) and they had significantly minor improvement as compared to younger patients (P<0.05). Moreover, their General Health score improvement was poorer and statistically insignificant (P=0.817)., Conclusions: Elderly patients not only have higher mortality and morbidity but also derive less benefit from CABG regarding certain aspects of QOL.

Objectives: The aim of the present study was to evaluate the performance of three different preoperative risk models in the prediction of postoperative morbidity and mortality in coronary artery bypass (CAB) surgery., Methods: Data on 1132 consecutive CAB patients were prospectively collected, including preoperative risk factors and postoperative morbidity and in-hospital mortality. The preoperative risk models CABDEAL, EuroSCORE and Cleveland model were used to predict morbidity and mortality. A C statistic (receiver operating characteristic (ROC) curve) was used to test the discrimination of these models., Results: The area under the ROC curve for morbidity was 0.772 for the CABDEAL, 0.694 for the EuroSCORE and 0.686 for the Cleveland model. Major morbidity due to postoperative complications occurred in 268 patients (23.6%). The mortality rate was 3.4% (n=38 patients). The ROC curve areas for prediction of mortality were 0.711 for the CABDEAL, 0.826 for the EuroSCORE and 0.858 for the Cleveland model., Conclusions: The CABDEAL model was initially developed for the prediction of major morbidity. Thus, it is not surprising that this model evinced the highest predictive value for increased morbidity in this database. Both the Cleveland and the EuroSCORE models were better predictive of mortality. These results have implications for the selection of risk indices for different purposes. The simple additive CABDEAL model can be used as a hand-held model for preoperative estimation of patients' risk of postoperative morbidity, while the EuroSCORE and Cleveland models are to be preferred for the prediction of mortality in a large patient sample.

The article presents a randomized controlled trial that examined if the intravenous administration of corticosteroids after cardiac surgery could prevent atrial fibrillation after the surgery. Surgeries studied in the trial include coronary artery bypass graft surgery, aortic valve replacement, or a combination of the two. Patients either received hydrocortisone or placebo. The authors of the study found that the incidence of atrial fibrillation after cardiac surgery was reduced by the administration of intravenous hydrocortisone after surgery.