Surgical risk prediction is to predict postoperative morbidity and mortality with internationally authoritative mathematical models. For patients undergoing high-risk cardiac surgery, surgical risk prediction is helpful for decision-making on treatment strategies and minimization of postoperative complications, which has gradually arouse interest of cardiac surgeons. There are many risk prediction models for cardiac surgery in the world, including European System for Cardiac Operative Risk Evaluation (EuroSCORE), Ontario Province Risk (OPR)score, Society of Thoracic Surgeons (STS)score, Cleveland Clinic risk score, Quality Measurement and Management Initiative (QMMI), American College of Cardiology/American Heart Association (ACC/AHA)Guidelines for Coronary Artery Bypass Graft Surgery, and Sino System for Coronary Operative Risk Evaluation (SinoSCORE). All these models are established from the database of thousands or ten thousands patients undergoing cardiac surgery in a specific region. As different sources of data and calculation imparities exist, there are probably bias and heterogeneities when the models are applied in other regions. How to decrease deviation and improve predicting effects had become the main research target in the future. This review focuses on the progress of risk prediction models for patients undergoing cardiac surgery.
ObjectiveTo evaluate the safety and myocardial protective results of single high-dose Atorvastatin loading before off-pump coronary artery bypass grafting (OPCAB). MethodsA total of 140 patients undergoing selective OPCAB in Jiangsu Province Hospital between February 2010 and August 2011 were recruited in this study. All the patients were randomly divided into a control group and an Atorvastatin loading group (single oral atorvastatin 80 mg)with 70 patients in each group. Biomarkers of cardiac injury including Troponin T (TnT), creatine kinase-MB (CK-MB)and myoglobin (Mb)were measured on admission, 6, 12, 24, 48, 72, 96 and 120 hours after OPCAB. Liver function (alanine aminotransferase (ALT), aspartate aminotransferase (AST)and total bilirubin (TBIL)), serum lipids (total cholesterol (TC), trigl-yceride (TG)and low-density lipoprotein cholesterol (LDL-C))and high-sensitivity C-reactive protein (hsCRP)were measured 2 days before OPCAB, 1, 4 and 7 days after OPCAB as well as before discharge. ResultsAll the patients successfully received OPCAB and were discharged. There was no statistical difference in preoperative clinical characteristics or above indexes between the 2 groups (P > 0.05). There was no statistical difference in ALT or AST between the 2 groups. Incidences of ALT (4.29% vs. 5.71%, P=1.000)and AST (4.29% vs. 0%, P=0.245)greater than 3 times above the upper normal limit were not statistically different between the 2 groups. Peak levels of postoperative TnT (0.23±0.27 ng/ml vs. 0.16±0.24 ng/ml, P=0.011), CK-MB (29.57±30.04 U/L vs. 17.73±14.07 U/L, P=0.001)and hsCRP (31.85±22.89 mg/L vs. 20.81±10.96 mg/L, P=0.001)of the control group were significantly higher than those of Atorvastatin loading group. Incidences of TnT greater than the upper normal limit (47.1% vs. 65.7%, P=0.041)and TnT greater than 5 times above the upper normal limit (8.6% vs. 22.9%, P=0.037)of Atorvastatin loading group were significantly lower than those of the control group. Incidence of CK-MB greater than the upper normal limit of Atorvastatin loading group was significantly lower than that of the control group (20.0% vs. 54.3%, P=0.000). ConclusionSingle high-dose Atorvastatin loading before OPCAB is safe and can alleviate postoperative myocardial injury.