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

Abstract

BackgroundClinical evidence in coronary surgery is usually derived from retrospective, single institutional series. This may introduce significant biases in the analysis of critical issues in the treatment of these patients. In order to avoid such methodological limitations, we planned a European multicenter, prospective study on coronary artery bypass grafting, the E-CABG registry.DesignThe E-CABG registry is a multicenter study and its data are prospectively collected from 13 centers of cardiac surgery in university and community hospitals located in six European countries (England, Italy, Finland, France, Germany, Sweden). Data on major and minor immediate postoperative adverse events will be collected. Data on late all-cause mortality, stroke, myocardial infarction and repeat revascularization will be collected during a 10-year follow-up period. These investigators provided a score from 0 to 10 for any major postoperative adverse events and their rounded medians were used to stratify the severity of these complications in four grades. The sum of these scores for each complication/intervention occurring after coronary artery bypass grafting will be used as an additive score for further stratification of the prognostic importance of these events.DiscussionThe E-CABG registry is expected to provide valuable data for identification of risk factors and treatment strategies associated with suboptimal outcome. These information may improve the safety and durability of coronary artery bypass grafting. The proposed classification of postoperative complications may become a valuable research tool to stratify the impact of such complications on the outcome of these patients and evaluate the burden of resources needed for their treatment.Clinical Trials numberNCT02319083

Safety of Preoperative Use of Ticagrelor With or Without Aspirin Compared With Aspirin Alone in Patients With Acute Coronary Syndromes Undergoing Coronary Artery Bypass Grafting

“…This study is registered at clinicaltrials.gov (identifier NCT02319083), and its detailed protocol and definition criteria have been previously published. 16 For the present analysis, all consecutive patients with unstable angina, non-ST-segment elevation myocardial infarction, and ST-segment elevation myocardial infarction exposed to ticagrelor with or without aspirin or to aspirin alone within 14 days of surgery were considered. Patients exposed to other antiplatelet agents (clopidogrel or prasugrel) were excluded from the analysis.…”

“…16 Secondary end points were chest drain output 12 hours after surgery, reexploration for excessive bleeding or tamponade, use of blood products, length of stay in the intensive care unit, sternal wound infection, and in-hospital mortality, as well as postoperative neurological, renal, and cardiac complications. We did not consider the length of in-hospital stay as an outcome measure because the timing of discharge in these patients could have been influenced by the availability of beds in rehabilitation clinics.…”

“…[12][13][14][15] To our knowledge, no data exist on any possible increased risk of bleeding associated with exposure to ticagrelor with or without aspirin compared with aspirin alone among patients with ACS undergoing CABG. The prospective European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) registry 16 aims to investigate the association of the use of ticagrelor vs aspirin alone with the risk of major bleeding and blood product requirement after surgery.…”

Reevaluation of the Diagnosis Related Groups System in Greece: The Example of Coronary Artery Bypass Graft Procedure

“…The risk characteristics of the group were comparable to the European average, based on the Euroscore scale. The high level of care offered to the patients is obvious if one takes into account the zero mortality (international margins 0%-3%) within the study group, as well as the excellent results in concern to the clinical indicators and the low rate of complications in general, compared to the internationally accepted [24][25][26][27][28] -Table 1. Despite that, the hospital length of stay reached an average of 11.5 days.…”

The feasibility and safety of off-pump coronary bypass surgery in emergency revascularization

“…The emergency of the procedure was defined and graded according to the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) severity classification (class 1: 39, 34.5%; class 2: 43, 38.1%; class 3: 27, 23.9%; class 4: 4, 3.5%) (12). Indication and urgency class are summarized in Table 1.…”