Validation of Bleeding Classifications in Coronary Artery Bypass Grafting

Debora Brascia, D. Reichart, F. Onorati, A. Perrotti, Vito G. Ruggieri, K. Bounader, J.P. Verhoye, G. Santarpino, T. Fischlein, D. Maselli, C. Dominici, G. Mariscalco, R. Gherli, A.S. Rubino, M. De Feo, C. Bancone, G. Gatti, F. Santini, M. Dalén, M. SaccocciG. Faggian, T. Tauriainen, E.-M. Kinnunen, F. Nicolini, T. Gherli, S. Rosato, F. Biancari

Research output: Contribution to journalArticle

Abstract

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. © 2016 Elsevier Inc.
Original languageEnglish
Pages (from-to)727-733
Number of pages7
JournalAmerican Journal of Cardiology
Volume119
Issue number5
DOIs
Publication statusPublished - 2017

Fingerprint

Coronary Artery Bypass
Registries
Hemorrhage
Enoxaparin
Wound Infection
Acute Kidney Injury
Mediastinitis
Decision Support Techniques
clopidogrel
Stroke
Safety
Area Under Curve
Mortality
Percutaneous Coronary Intervention
ROC Curve
Aspirin
Blood Platelets
Multivariate Analysis
Organizations
poly(divinyl-co-N-vinylpyrrolidinone)

Keywords

  • acute kidney failure
  • aged
  • area under the curve
  • Article
  • bleeding
  • cerebrovascular accident
  • coronary artery bypass graft
  • disease classification
  • EuroSCORE
  • female
  • human
  • major clinical study
  • male
  • mediastinitis
  • mortality
  • perioperative period
  • priority journal
  • prospective study
  • receiver operating characteristic
  • register
  • surgical risk
  • treatment outcome
  • wound infection
  • Acute Kidney Injury
  • classification
  • Coronary Stenosis
  • mammary artery
  • middle aged
  • multivariate analysis
  • peroperative complication
  • postoperative hemorrhage
  • procedures
  • risk factor
  • severity of illness index
  • statistical model
  • Stroke
  • transplantation
  • validation study
  • anticoagulant agent
  • antithrombocytic agent
  • Aged
  • Anticoagulants
  • Coronary Artery Bypass
  • Female
  • Hemorrhage
  • Humans
  • Intraoperative Complications
  • Logistic Models
  • Male
  • Mammary Arteries
  • Middle Aged
  • Multivariate Analysis
  • Platelet Aggregation Inhibitors
  • Postoperative Hemorrhage
  • Prospective Studies
  • Registries
  • Risk Factors
  • ROC Curve
  • Severity of Illness Index

Cite this

Brascia, D., Reichart, D., Onorati, F., Perrotti, A., Ruggieri, V. G., Bounader, K., ... Biancari, F. (2017). Validation of Bleeding Classifications in Coronary Artery Bypass Grafting. American Journal of Cardiology, 119(5), 727-733. https://doi.org/10.1016/j.amjcard.2016.11.027

Validation of Bleeding Classifications in Coronary Artery Bypass Grafting. / Brascia, Debora ; Reichart, D.; Onorati, F.; Perrotti, A.; Ruggieri, Vito G.; Bounader, K.; Verhoye, J.P.; Santarpino, G.; Fischlein, T.; Maselli, D.; Dominici, C.; Mariscalco, G.; Gherli, R.; Rubino, A.S.; De Feo, M.; Bancone, C.; Gatti, G.; Santini, F.; Dalén, M.; Saccocci, M.; Faggian, G.; Tauriainen, T.; Kinnunen, E.-M.; Nicolini, F.; Gherli, T.; Rosato, S.; Biancari, F.

In: American Journal of Cardiology, Vol. 119, No. 5, 2017, p. 727-733.

Research output: Contribution to journalArticle

Brascia, D, Reichart, D, Onorati, F, Perrotti, A, Ruggieri, VG, Bounader, K, Verhoye, JP, Santarpino, G, Fischlein, T, Maselli, D, Dominici, C, Mariscalco, G, Gherli, R, Rubino, AS, De Feo, M, Bancone, C, Gatti, G, Santini, F, Dalén, M, Saccocci, M, Faggian, G, Tauriainen, T, Kinnunen, E-M, Nicolini, F, Gherli, T, Rosato, S & Biancari, F 2017, 'Validation of Bleeding Classifications in Coronary Artery Bypass Grafting', American Journal of Cardiology, vol. 119, no. 5, pp. 727-733. https://doi.org/10.1016/j.amjcard.2016.11.027
Brascia D, Reichart D, Onorati F, Perrotti A, Ruggieri VG, Bounader K et al. Validation of Bleeding Classifications in Coronary Artery Bypass Grafting. American Journal of Cardiology. 2017;119(5):727-733. https://doi.org/10.1016/j.amjcard.2016.11.027
Brascia, Debora ; Reichart, D. ; Onorati, F. ; Perrotti, A. ; Ruggieri, Vito G. ; Bounader, K. ; Verhoye, J.P. ; Santarpino, G. ; Fischlein, T. ; Maselli, D. ; Dominici, C. ; Mariscalco, G. ; Gherli, R. ; Rubino, A.S. ; De Feo, M. ; Bancone, C. ; Gatti, G. ; Santini, F. ; Dalén, M. ; Saccocci, M. ; Faggian, G. ; Tauriainen, T. ; Kinnunen, E.-M. ; Nicolini, F. ; Gherli, T. ; Rosato, S. ; Biancari, F. / Validation of Bleeding Classifications in Coronary Artery Bypass Grafting. In: American Journal of Cardiology. 2017 ; Vol. 119, No. 5. pp. 727-733.
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title = "Validation of Bleeding Classifications in Coronary Artery Bypass Grafting",
abstract = "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. {\circledC} 2016 Elsevier Inc.",
keywords = "acute kidney failure, aged, area under the curve, Article, bleeding, cerebrovascular accident, coronary artery bypass graft, disease classification, EuroSCORE, female, human, major clinical study, male, mediastinitis, mortality, perioperative period, priority journal, prospective study, receiver operating characteristic, register, surgical risk, treatment outcome, wound infection, Acute Kidney Injury, classification, Coronary Stenosis, mammary artery, middle aged, multivariate analysis, peroperative complication, postoperative hemorrhage, procedures, risk factor, severity of illness index, statistical model, Stroke, transplantation, validation study, anticoagulant agent, antithrombocytic agent, Aged, Anticoagulants, Coronary Artery Bypass, Female, Hemorrhage, Humans, Intraoperative Complications, Logistic Models, Male, Mammary Arteries, Middle Aged, Multivariate Analysis, Platelet Aggregation Inhibitors, Postoperative Hemorrhage, Prospective Studies, Registries, Risk Factors, ROC Curve, Severity of Illness Index",
author = "Debora Brascia and D. Reichart and F. Onorati and A. Perrotti and Ruggieri, {Vito G.} and K. Bounader and J.P. Verhoye and G. Santarpino and T. Fischlein and D. Maselli and C. Dominici and G. Mariscalco and R. Gherli and A.S. Rubino and {De Feo}, M. and C. Bancone and G. Gatti and F. Santini and M. Dal{\'e}n and M. Saccocci and G. Faggian and T. Tauriainen and E.-M. Kinnunen and F. Nicolini and T. Gherli and S. Rosato and F. Biancari",
note = "Export Date: 11 April 2018 CODEN: AJCDA Correspondence Address: Biancari, F.; Department of Surgery, Oulu University HospitalFinland; email: faustobiancari@yahoo.it Chemicals/CAS: Anticoagulants; Platelet Aggregation Inhibitors References: Eikelboom, J.W., Mehta, S.R., Anand, S.S., Xie, C., Fox, K.A.A., Yusuf, S., Adverse impact of bleeding on prognosis in patients with acute coronary syndromes (2006) Circulation, 114, pp. 774-782; Rao, S.V., O'Grady, K., Pieper, K.S., Granger, C.B., Newby, K.L., Van de Werf, F., Mahaffey, K.W., Harrington, R.A., Impact of bleeding severity on clinical outcomes among patients with acute coronary syndromes (2005) Am J Cardiol, 96, pp. 1200-1206; Habib, R.H., Zacharias, A., Schwann, T.A., Riordan, C.J., Durham, S.J., Shah, A., Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be changed? (2003) J Thorac Cardiovasc Surg, 125, pp. 1438-1450; Steg, P.G., Huber, K., Andreotti, F., Arnesen, H., Atar, D., Badimon, L., Bassand, J.P., Collet, J.P., Bleeding in acute coronary syndromes and percutaneous coronary interventions: position paper by the Working Group on Thrombosis of the European Society of Cardiology (2011) Eur Heart J, 32, pp. 1854-1864; Mehran, R., Pocock, S.J., Nikolsky, E., Clayton, T., Dangas, G.D., Kirtane, A.J., Parise, H., Stone, G.W., A risk score to predict bleeding in patients with acute coronary syndromes (2010) J Am Coll Cardiol, 55, pp. 2556-2566; Mehran, R., Rao, S.V., Bhatt, D.L., Gibson, C.M., Caixeta, A., Eikelboom, J., Kaul, S., White, H., Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium (2011) Circulation, 123, pp. 2736-2747; Cohen, M., Demers, C., Gurfinkel, E.P., Turpie, A.G., Fromell, G.J., Goodman, S., Langer, A., Bigonzi, F., A comparison of low-molecular-weight heparin with unfractionated heparin for unstable coronary artery disease. Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events Study Group (1997) N Engl J Med, 337, pp. 447-452. , PubMed PMID: 9250846; Mehta, S.R., Bassand, J.P., Chrolavicius, S., Diaz, R., Eikelboom, J.W., Fox, K.A., Granger, C.B., Yusuf, S., Dose comparisons of clopidogrel and aspirin in acute coronary syndromes (2010) N Engl J Med, 363, pp. 930-942; Budaj, A., Eikelboom, J.W., Mehta, S.R., Afzal, R., Chrolavicius, S., Bassand, J.P., Fox, K.A., Yusuf, S., Improving clinical outcomes by reducing bleeding in patients with non-ST-elevation acute coronary syndromes (2009) Eur Heart J, 30, pp. 655-661; An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. The GUSTO investigators (1993) N Engl J Med, 329, pp. 673-682; Kastrati, A., Neumann, F.J., Mehilli, J., Byrne, R.A., Iijima, R., B{\"u}ttner, H.J., Khattab, A.A., Sch{\"o}mig, A., Bivalirudin versus unfractionated heparin during percutaneous coronary intervention (2008) N Engl J Med, 359, pp. 688-696; Wallentin, L., Becker, R.C., Budaj, A., Cannon, C.P., Emanuelsson, H., Held, C., Horrow, J., Thors{\'e}n, M., Ticagrelor versus clopidogrel in patients with acute coronary syndromes (2009) N Engl J Med, 361, pp. 1045-1057; Feit, F., Voeltz, M.D., Attubato, M.J., Lincoff, A.M., Chew, D.P., Bittl, J.A., Topol, E.J., Manoukian, S.V., Predictors and impact of major hemorrhage on mortality following percutaneous coronary intervention from the REPLACE-2 Trial (2007) Am J Cardiol, 100, pp. 1364-1369; Montalescot, G., White, H.D., Gallo, R., Cohen, M., Steg, P.G., Aylward, P.E., Bode, C., Steinhubl, S.R., Enoxaparin versus unfractionated heparin in elective percutaneous coronary intervention (2006) N Engl J Med, 355, pp. 1006-1017; Rao, A.K., Pratt, C., Berke, A., Jaffe, A., Ockene, I., Schreiber, T.L., Bell, W.R., Terrin, M.L., Thrombolysis in Myocardial Infarction (TIMI) Trial-phase I: hemorrhagic manifestations and changes in plasma fibrinogen and the fibrinolytic system in patients treated with recombinant tissue plasminogen activator and streptokinase (1988) J Am Coll Cardiol, 11, pp. 1-11; Moscucci, M., Fox, K.A., Cannon, C.P., Klein, W., L{\'o}pez-Send{\'o}n, J., Montalescot, G., White, K., Goldberg, R.J., Predictors of major bleeding in acute coronary syndromes: the Global Registry of Acute Coronary Events (GRACE) (2003) Eur Heart J, 24, pp. 1815-1823; Amlani, S., Nadarajah, T., Afzal, R., Pal-Sayal, R., Eikelboom, J.W., Natarajan, M.K., Mortality and morbidity following a major bleed in a registry population with acute ST elevation myocardial infarction (2010) J Thromb Thrombolysis, 30, pp. 434-440; Dyke, C., Aronson, S., Dietrich, W., Hofmann, A., Karkouti, K., Levi, M., Murphy, G.J., Ranucci, M., Universal definition of perioperative bleeding in adult cardiac surgery (2014) J Thorac Cardiovasc Surg, 147, pp. 1458-1463; Biancari, F., Ruggieri, V.G., Perrotti, A., Svenarud, P., Dal{\'e}n, M., Onorati, F., Faggian, G., Juvonen, T., European multicenter study on coronary artery bypass grafting (E-CABG registry): study protocol for a prospective clinical registry and proposal of classification of postoperative complications (2015) J Cardiothorac Surg, 10, p. 90; Nashef, S.A., Roques, F., Sharples, L.D., Nilsson, J., Smith, C., Goldstone, A.R., Lockowandt, U., EuroSCORE II (2012) Eur J Cardiothorac Surg, 41, pp. 734-744; KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) (2009) Kidney Int Suppl, 113, pp. S1-S130; Mangram, A.J., Horan, T.C., Pearson, M.L., Silver, L.C., Jarvis, W.R., Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee (1999) Infect Control Hosp Epidemiol, 20, pp. 250-278; DeLong, E.R., DeLong, D.M., Clarke-Pearson, D.L., Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach (1988) Biometrics, 44, pp. 837-845; Vickers, A.J., Elkin, E.B., Decision curve analysis: a novel method for evaluating prediction models (2006) Med Decis Making, 26, pp. 565-574; Kikkert, W.J., van Geloven, N., van der Laan, M.H., Vis, M.M., Baan, J., Jr., Koch, K.T., Peters, R.J., Henriques, J.P., The prognostic value of bleeding academic research consortium (BARC)-defined bleeding complications in ST-segment elevation myocardial infarction: a comparison with the TIMI (Thrombolysis In Myocardial Infarction), GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries), and ISTH (International Society on Thrombosis and Haemostasis) bleeding classifications (2014) J Am Coll Cardiol, 63, pp. 1866-1875; Kappetein, A.P., Head, S.J., G{\'e}n{\'e}reux, P., Piazza, N., van Mieghem, N.M., Blackstone, E.H., Brott, T.G., Leon, M.B., Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document (2012) J Am Coll Cardiol, 60, pp. 1438-1454; Kinnunen, E.M., Mosorin, M.A., Perrotti, A., Ruggieri, V.G., Svenarud, P., Dal{\'e}n, M., Onorati, F., Biancari, F., Validation of a new classification method of postoperative complications in patients undergoing coronary artery surgery (2016) J Cardiothorac Vasc Anesth, 30, pp. 330-337",
year = "2017",
doi = "10.1016/j.amjcard.2016.11.027",
language = "English",
volume = "119",
pages = "727--733",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Validation of Bleeding Classifications in Coronary Artery Bypass Grafting

AU - Brascia, Debora

AU - Reichart, D.

AU - Onorati, F.

AU - Perrotti, A.

AU - Ruggieri, Vito G.

AU - Bounader, K.

AU - Verhoye, J.P.

AU - Santarpino, G.

AU - Fischlein, T.

AU - Maselli, D.

AU - Dominici, C.

AU - Mariscalco, G.

AU - Gherli, R.

AU - Rubino, A.S.

AU - De Feo, M.

AU - Bancone, C.

AU - Gatti, G.

AU - Santini, F.

AU - Dalén, M.

AU - Saccocci, M.

AU - Faggian, G.

AU - Tauriainen, T.

AU - Kinnunen, E.-M.

AU - Nicolini, F.

AU - Gherli, T.

AU - Rosato, S.

AU - Biancari, F.

N1 - Export Date: 11 April 2018 CODEN: AJCDA Correspondence Address: Biancari, F.; Department of Surgery, Oulu University HospitalFinland; email: faustobiancari@yahoo.it Chemicals/CAS: Anticoagulants; Platelet Aggregation Inhibitors References: Eikelboom, J.W., Mehta, S.R., Anand, S.S., Xie, C., Fox, K.A.A., Yusuf, S., Adverse impact of bleeding on prognosis in patients with acute coronary syndromes (2006) Circulation, 114, pp. 774-782; Rao, S.V., O'Grady, K., Pieper, K.S., Granger, C.B., Newby, K.L., Van de Werf, F., Mahaffey, K.W., Harrington, R.A., Impact of bleeding severity on clinical outcomes among patients with acute coronary syndromes (2005) Am J Cardiol, 96, pp. 1200-1206; Habib, R.H., Zacharias, A., Schwann, T.A., Riordan, C.J., Durham, S.J., Shah, A., Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be changed? (2003) J Thorac Cardiovasc Surg, 125, pp. 1438-1450; Steg, P.G., Huber, K., Andreotti, F., Arnesen, H., Atar, D., Badimon, L., Bassand, J.P., Collet, J.P., Bleeding in acute coronary syndromes and percutaneous coronary interventions: position paper by the Working Group on Thrombosis of the European Society of Cardiology (2011) Eur Heart J, 32, pp. 1854-1864; Mehran, R., Pocock, S.J., Nikolsky, E., Clayton, T., Dangas, G.D., Kirtane, A.J., Parise, H., Stone, G.W., A risk score to predict bleeding in patients with acute coronary syndromes (2010) J Am Coll Cardiol, 55, pp. 2556-2566; Mehran, R., Rao, S.V., Bhatt, D.L., Gibson, C.M., Caixeta, A., Eikelboom, J., Kaul, S., White, H., Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium (2011) Circulation, 123, pp. 2736-2747; Cohen, M., Demers, C., Gurfinkel, E.P., Turpie, A.G., Fromell, G.J., Goodman, S., Langer, A., Bigonzi, F., A comparison of low-molecular-weight heparin with unfractionated heparin for unstable coronary artery disease. Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events Study Group (1997) N Engl J Med, 337, pp. 447-452. , PubMed PMID: 9250846; Mehta, S.R., Bassand, J.P., Chrolavicius, S., Diaz, R., Eikelboom, J.W., Fox, K.A., Granger, C.B., Yusuf, S., Dose comparisons of clopidogrel and aspirin in acute coronary syndromes (2010) N Engl J Med, 363, pp. 930-942; Budaj, A., Eikelboom, J.W., Mehta, S.R., Afzal, R., Chrolavicius, S., Bassand, J.P., Fox, K.A., Yusuf, S., Improving clinical outcomes by reducing bleeding in patients with non-ST-elevation acute coronary syndromes (2009) Eur Heart J, 30, pp. 655-661; An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. The GUSTO investigators (1993) N Engl J Med, 329, pp. 673-682; Kastrati, A., Neumann, F.J., Mehilli, J., Byrne, R.A., Iijima, R., Büttner, H.J., Khattab, A.A., Schömig, A., Bivalirudin versus unfractionated heparin during percutaneous coronary intervention (2008) N Engl J Med, 359, pp. 688-696; Wallentin, L., Becker, R.C., Budaj, A., Cannon, C.P., Emanuelsson, H., Held, C., Horrow, J., Thorsén, M., Ticagrelor versus clopidogrel in patients with acute coronary syndromes (2009) N Engl J Med, 361, pp. 1045-1057; Feit, F., Voeltz, M.D., Attubato, M.J., Lincoff, A.M., Chew, D.P., Bittl, J.A., Topol, E.J., Manoukian, S.V., Predictors and impact of major hemorrhage on mortality following percutaneous coronary intervention from the REPLACE-2 Trial (2007) Am J Cardiol, 100, pp. 1364-1369; Montalescot, G., White, H.D., Gallo, R., Cohen, M., Steg, P.G., Aylward, P.E., Bode, C., Steinhubl, S.R., Enoxaparin versus unfractionated heparin in elective percutaneous coronary intervention (2006) N Engl J Med, 355, pp. 1006-1017; Rao, A.K., Pratt, C., Berke, A., Jaffe, A., Ockene, I., Schreiber, T.L., Bell, W.R., Terrin, M.L., Thrombolysis in Myocardial Infarction (TIMI) Trial-phase I: hemorrhagic manifestations and changes in plasma fibrinogen and the fibrinolytic system in patients treated with recombinant tissue plasminogen activator and streptokinase (1988) J Am Coll Cardiol, 11, pp. 1-11; Moscucci, M., Fox, K.A., Cannon, C.P., Klein, W., López-Sendón, J., Montalescot, G., White, K., Goldberg, R.J., Predictors of major bleeding in acute coronary syndromes: the Global Registry of Acute Coronary Events (GRACE) (2003) Eur Heart J, 24, pp. 1815-1823; Amlani, S., Nadarajah, T., Afzal, R., Pal-Sayal, R., Eikelboom, J.W., Natarajan, M.K., Mortality and morbidity following a major bleed in a registry population with acute ST elevation myocardial infarction (2010) J Thromb Thrombolysis, 30, pp. 434-440; Dyke, C., Aronson, S., Dietrich, W., Hofmann, A., Karkouti, K., Levi, M., Murphy, G.J., Ranucci, M., Universal definition of perioperative bleeding in adult cardiac surgery (2014) J Thorac Cardiovasc Surg, 147, pp. 1458-1463; Biancari, F., Ruggieri, V.G., Perrotti, A., Svenarud, P., Dalén, M., Onorati, F., Faggian, G., Juvonen, T., European multicenter study on coronary artery bypass grafting (E-CABG registry): study protocol for a prospective clinical registry and proposal of classification of postoperative complications (2015) J Cardiothorac Surg, 10, p. 90; Nashef, S.A., Roques, F., Sharples, L.D., Nilsson, J., Smith, C., Goldstone, A.R., Lockowandt, U., EuroSCORE II (2012) Eur J Cardiothorac Surg, 41, pp. 734-744; KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) (2009) Kidney Int Suppl, 113, pp. S1-S130; Mangram, A.J., Horan, T.C., Pearson, M.L., Silver, L.C., Jarvis, W.R., Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee (1999) Infect Control Hosp Epidemiol, 20, pp. 250-278; DeLong, E.R., DeLong, D.M., Clarke-Pearson, D.L., Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach (1988) Biometrics, 44, pp. 837-845; Vickers, A.J., Elkin, E.B., Decision curve analysis: a novel method for evaluating prediction models (2006) Med Decis Making, 26, pp. 565-574; Kikkert, W.J., van Geloven, N., van der Laan, M.H., Vis, M.M., Baan, J., Jr., Koch, K.T., Peters, R.J., Henriques, J.P., The prognostic value of bleeding academic research consortium (BARC)-defined bleeding complications in ST-segment elevation myocardial infarction: a comparison with the TIMI (Thrombolysis In Myocardial Infarction), GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries), and ISTH (International Society on Thrombosis and Haemostasis) bleeding classifications (2014) J Am Coll Cardiol, 63, pp. 1866-1875; Kappetein, A.P., Head, S.J., Généreux, P., Piazza, N., van Mieghem, N.M., Blackstone, E.H., Brott, T.G., Leon, M.B., Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document (2012) J Am Coll Cardiol, 60, pp. 1438-1454; Kinnunen, E.M., Mosorin, M.A., Perrotti, A., Ruggieri, V.G., Svenarud, P., Dalén, M., Onorati, F., Biancari, F., Validation of a new classification method of postoperative complications in patients undergoing coronary artery surgery (2016) J Cardiothorac Vasc Anesth, 30, pp. 330-337

PY - 2017

Y1 - 2017

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. © 2016 Elsevier Inc.

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. © 2016 Elsevier Inc.

KW - acute kidney failure

KW - aged

KW - area under the curve

KW - Article

KW - bleeding

KW - cerebrovascular accident

KW - coronary artery bypass graft

KW - disease classification

KW - EuroSCORE

KW - female

KW - human

KW - major clinical study

KW - male

KW - mediastinitis

KW - mortality

KW - perioperative period

KW - priority journal

KW - prospective study

KW - receiver operating characteristic

KW - register

KW - surgical risk

KW - treatment outcome

KW - wound infection

KW - Acute Kidney Injury

KW - classification

KW - Coronary Stenosis

KW - mammary artery

KW - middle aged

KW - multivariate analysis

KW - peroperative complication

KW - postoperative hemorrhage

KW - procedures

KW - risk factor

KW - severity of illness index

KW - statistical model

KW - Stroke

KW - transplantation

KW - validation study

KW - anticoagulant agent

KW - antithrombocytic agent

KW - Aged

KW - Anticoagulants

KW - Coronary Artery Bypass

KW - Female

KW - Hemorrhage

KW - Humans

KW - Intraoperative Complications

KW - Logistic Models

KW - Male

KW - Mammary Arteries

KW - Middle Aged

KW - Multivariate Analysis

KW - Platelet Aggregation Inhibitors

KW - Postoperative Hemorrhage

KW - Prospective Studies

KW - Registries

KW - Risk Factors

KW - ROC Curve

KW - Severity of Illness Index

U2 - 10.1016/j.amjcard.2016.11.027

DO - 10.1016/j.amjcard.2016.11.027

M3 - Article

VL - 119

SP - 727

EP - 733

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 5

ER -