ÜÇ FARKLI RİSK SKORLAMA SİSTEMİNİN KORONER ARTER BAYPAS GREFTLEME YAPILAN HASTALARDA MORTALİTE ÖNGÖRMEDEKİ ETKİNLİKLERİNİN KARŞILAŞTIRILMASI

Giriş: Çalışmamızda dünya genelinde kabul görmüş üç skorlama sistemini koroner arter bypass cerrahisi geçiren hastalarda karşılaştırarak bu sistemlerin globalleşmesine katkı sağlamak ve hasta populasyonumuza en uygun risk değerlendirme sistemini tespit etmek için bu çalışmayı planladık. Materyal-Metod: Ocak 2003 - Aralık 2004 tarihleri arasında Türkiye Yüksek İhtisas Hastanesi Kalp ve Damar Cerrahisi Kliniği’nde ardışık olarak koroner arter bypass greftleme (KABG) operasyonu yapılan 2120 hasta çalışmaya dahil edildi. Bu incelemede ameliyat dönemi ve ameliyattan sonra 30 gün içinde olan ölümler mortalite olarak kabul edildi. Hastalar çalışmada kullanılan preoperatif risk değerlendirme sistemlerinin öngördüğü şekilde düşük, orta ve yüksek risk gruplarına ayrıldı. Kullanılan risk değerlendirme sistemlerinde beklenen ve gözlenen mortaliteler karşılaştırıldı. Bulgular: Her üç risk grubunda da gözlenen mortalite oranları ile beklenen mortalite oranları yönünden EuroSCORE sisteminde istatistiksel olarak anlamlı fark saptanmadı (p>0.05). Parsonnet ile yapılan değerlendirmede düşük ve orta risk grubunda gözlenen mortalite ve beklenen mortalite oranları yönünden istatistiksel olarak gözlenen mortalitenin az olması yönünde anlamlı bir fark görüldü (p0.05). Ontario Province Risk (OPR) sistemiyle yapılan değerlendirmede her üç risk grubu içinde gözlenen ve beklenen mortalite oranları arasında düşük risk grubunda anlamlı fark saptanırken (p0.05). Sonuç: EuroSCORE risk sınıflamasının belirli hasta grubunda literatür ile uyumlu sonuçlar verdiğini ve bu skorlama sisteminin bölgemizdeki KABG hasta popülasyonunda preoperatif risk değerlendirmesi için güvenilir olarak kullanılabileceğini söyleyebiliriz.

The Comparison of the Efficacy of Three Different Risk- Scoring Systems on Predicting the Mortality Rates of Patients Undergoing Coronary Artery Bypass Grafting

Introduction: We aimed to compare the efficacy of three different well-known and commonly used mortalityrisk-scoring systems and to provide a more suitable scoring system for our patient population.Material-Method: A total of 2120 patients who had undergone a CABG operation in Türkiye Yüksek İhtisasHospital Cardiovascular Surgery Clinic between January 2003 – December 2004 included in this study. The inhospitaldeaths and the deaths in postoperative 30 days were accepted as mortality. The patients were dividedinto low, moderate and high-risk groups as the risk scoring systems prerequisites. The predicted mortalityrates by the risk scoring systems and the observed mortality rates were compared.Results: The observed mortality rates and the predicted mortality rates by EuroSCORE were similar betweenthe groups (p>0.05). The observed mortality rates of low and moderate risk groups were significantly lowerthan the predicted mortality rates with Parsonnet risk scoring system (p0.05). The predicted mortality rates with Ontario Province Risk (OPR) scoring system andobserved mortality rates in the low risk group were significantly different (p0.05).Conclusion: The EuroSCORE risk scoring system results were similar to the results in the literature. It is areliable way of risk prediction for the patients undergoing CABG surgery in our region.

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