Comparative Application of Multivariate Models Developed in Italy and Europe to Predict Early (28 Days) and Late (1 Year) Postoperative Death after On- or Off-Pump Coronary Artery Bypass Grafting


  • Alfonso Sciangula
  • Paolo Emilio Puddu
  • Michele Schiariti
  • Maria Cristina Acconcia
  • Bindo Missiroli
  • Ugo Papalia
  • Carlo Gaudio
  • Gianluca Martinelli
  • Mauro Cassese



Objectives. The aim of this study was to compare the risk of death predictive performances of the OP-RISK, EuroSCORE, and Italian coronary artery bypass grafting (CABG) Outcome studies' functions when applied to a southern Italian cardiac surgery center (Sant'Anna hospital in Catanzaro [SAHCZ]), which contributed data to the Italian CABG Outcome study, and to see if this predictive index may be applied to on- and off-pump interventions.

Methods. The OP-RISK study data set was used to derive Weibull and logistic functions to predict early (28 days) and late (1 year) death rates following CABG based on ejection fraction, heart rate, age, and aortic cross-clamping time. Then the data of 385 CABG patients who underwent operations in 2003 in SAHCZ were collected with 1-year follow-up data, which also included data used to obtain EuroSCORE and Italian CABG Outcome study risk indices.

Results. Short- and long-term observed mortality rates after CABG were 2.59% and 5.88% in the SAHCZ series, largely dependent on whether CABG was alone (1.26% and 3.55%) or associated with ventriculoplasty (4.87% and 10.81%) or valve surgery (15.38% and 28.57%). There was a significant increasing trend (P = .002) of observed death rates in equinumeric tertiles of either OP-RISK (both Weibull and logistic) or EuroSCORE in the short term, whereas the trend was not significant for the Italian CABG Outcome study index. OP-RISK functions were significantly predictive for the long term (P < .005), as well as when only ejection fraction, heart rate, and age were considered (P < .011).

Conclusions. It is essential to use clinical data following CABG when outcome prediction is concerned. OP-RISK and EuroSCORE indices are equally predictive in our experience, and a statistically significant (P = 0.02) difference was observed with the Italian CABG Outcome study index, whose trend in tertiles of calculated risk was not apparent, which is unexpected and unexplained. OP-RISK functions were adequate for long-term prediction. Since aortic cross-clamping time may be absent from tested predictive functions (for both short and long term), off-pump CABG mortality may also be predicted as similar to on-pump intervention mortality.


Agabiti N, Ancona C, Forastiere F, et al. 2003. Evaluating outcomes of hospital care following coronary artery bypass surgery in Rome, Italy. Eur J Cardiothorac Surg23: 599-606.nDe Paulis R. 2003. On the fine balance between the completeness of clinical data and the effective use of outcome data. Eur J Cardiothorac Surg23:609-10.nGimelli A, L'Abbate A, Glauber M, et al. 2006. Cardiac imaging improves risk stratification in high-risk patients undergoing surgical revascularization. J Cardiovasc Med7:51-6.nKennedy JW, Kaiser GC, Fisher LD, et al. 1980. Multivariate discriminant analysis of the clinical and angiographic predictors of operative mortality from the Collaborative Study in Coronary Artery Surgery (CASS). J Thorac Cardiovasc Surg80:876-7.nLoop FD, Berrettoni JN, Pichard A, et al. 1975. Selection of the candidate for myocardial revascularization: a profile of high risk based on multivariate analysis. J Thorac Cardiovasc Surg69:40-51.nMenotti A, Puddu PE, Lanti M. 2000. Comparison of the Farmingham risk function-based coronary chart with risk function from an Italian population study. Eur Heart J21:365-70.nMenotti A, Puddu PE, Lanti M. 2004. II rischio in cardiologia: dalla teoria alla pratica. Pavia: Edizioni Internazionali srl; 1-189.nNashef SAM, Roques F, Michel P, et al. 1999. EuroSCORE study group. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg16:9-13.nNashef SAM, Roques F, Hammill BG, et al. 2002. Validation of European system for cardiac operative risk evaluation (EuroSCORE) in North American cardiac surgery. Eur J Cardiothorac Surg22:101-5.nNashef SAM, Menicanti L. 2006. The Italian job on CABG outcomes (Editorial comments). Eur J Cardiothorac Surg29:62-4.nNilsson J, Algotsson L, Höglund P, et al. 2006. Comparison of 19 preoperative risk stratification models in open-heart surgery. Eur Heart J27:867-74.nO'Connor GT, Plume SK, Olmstead EM, et al. 1992. Multivariate prediction of in-hospital mortality associated with coronary artery bypass graft surgery. Northern New England Cardiovascular Disease Study Group. Circulation85:2110-8.nParsonnet V, Dean D, Bernstein AD, et al. 1989. A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease. Circulation79:3-12.nPuddu PE, Jouve R, Langlet F, et al. 1988. Prevention of postischemic ventricular fibrillation late after right or left stellate ganglionectomy in dogs. Circulation77:935-46.nPuddu PE, Monti F, Brancaccio GL, et al. 1997. Analisi univariata su potenziali fattori di rischio della mortalità precoce (entro 28 giorni) dopo bypass aortocoronarico in Italia. Cardiologia42:957-69.nPuddu PE, Brancaccio G, Leacche M, et al. 2002. Prediction of early and delayed postoperative deaths after coronary artery bypass surgery in Italy. Multivariate prediction based on Cox and logistic models and a chart based on the accelerated failure time model. Ital Heart J3:166-81.nRoques F, Gabrielle F, Michel P, et al. 1995. Quality of care in adult heart surgery: proposal for a self-assessment approach based on a French multicenter study. Eur J Cardiothorac Surg9:43-40.nRoques F, Nashef SAM, Michel P, et al. 1999. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg15:816-23.nRoques F, Nashef SAM, Michel P, et al. 2000. Does EuroSCORE work in individual European countries? Eur J Cardiothorac Surg18:27-30.nSeccareccia F, Capriani P, Diemoz S, et al. 2003. Gruppo di Ricerca Italiano "Progetto BPAC." Ital Heart J Suppl4:32-8.nSeccareccia F, Perucci CA, D'Errigo P, et al. 2006. The 'Italian CABG Outcome Study': short-term outcomes in patients with coronary artery bypass graft surgery. Eur J Cardiothorac Surg29:56-62.nShroyer AL, Coombs LP, Peterson ED, et al. 2003. The Society of Thoracic Surgeons: 30-day operative mortality and morbidity risk models. Ann Thorac Surg75: 1856-64.nUgolini C, Nobilio L. 2004. Risk adjustment for coronary artery bypass graft surgery: an administrative approach versus EuroSCORE. Int J Qual Health Care16:157-64.nWijeysundera DN, Beattie WS, Djaiani G, et al. 2005. Off-pump coronary artery surgery for reducing mortality and morbidity. Meta-analysis of randomized and observational Studies. J Am Coll Cardiol46:872-82.nYap CH, Reid C, Yii M, Rowland MA, et al. 2006. Validation of EuroSCORE model in Australia. Eur J Cardiothorac Surg29:441-6.n



How to Cite

Sciangula, A., Puddu, P. E., Schiariti, M., Acconcia, M. C., Missiroli, B., Papalia, U., Gaudio, C., Martinelli, G., & Cassese, M. (2007). Comparative Application of Multivariate Models Developed in Italy and Europe to Predict Early (28 Days) and Late (1 Year) Postoperative Death after On- or Off-Pump Coronary Artery Bypass Grafting. The Heart Surgery Forum, 10(4), E258-E266.




Most read articles by the same author(s)