ÜÇ FARKLI RİSK SKORLAMA SİSTEMİNİN KORONER ARTER BAYPAS GREFTLEME YAPILAN HASTALARDA MORTALİTE ÖNGÖRMEDEKİ ETKİNLİKLERİNİN KARŞILAŞTIRILMASI The Comparison of the Efficacy of Three Different Risk-Scoring Systems on Predicting the Mortality Rates of Patients Undergoing Coronary Artery Bypass Grafting

Giris: Calismamizda dunya genelinde kabul gormus uc skorlama sistemini koroner arter bypass cerrahisi geciren hastalarda karsilastirarak bu sistemlerin globallesmesine katki saglamak ve hasta populasyonumuza en uygun risk degerlendirme sistemini tespit etmek icin bu calismayi planladik. Materyal-Metod: Ocak 2003 - Aralik 2004 tarihleri arasinda Turkiye Yuksek Ihtisas Hastanesi Kalp ve Damar Cerrahisi Klinigi’nde ardisik olarak koroner arter bypass greftleme (KABG) operasyonu yapilan 2120 hasta calismaya dahil edildi. Bu incelemede ameliyat donemi ve ameliyattan sonra 30 gun icinde olan olumler mortalite olarak kabul edildi. Hastalar calismada kullanilan preoperatif risk degerlendirme sistemlerinin ongordugu sekilde dusuk, orta ve yuksek risk gruplarina ayrildi. Kullanilan risk degerlendirme sistemlerinde beklenen ve gozlenen mortaliteler karsilastirildi. Bulgular: Her uc risk grubunda da gozlenen mortalite oranlari ile beklenen mortalite oranlari yonunden EuroSCORE sisteminde istatistiksel olarak anlamli fark saptanmadi (p>0.05). Parsonnet ile yapilan degerlendirmede dusuk ve orta risk grubunda gozlenen mortalite ve beklenen mortalite oranlari yonunden istatistiksel olarak gozlenen mortalitenin az olmasi yonunde anlamli bir fark goruldu (p 0.05). Ontario Province Risk (OPR) sistemiyle yapilan degerlendirmede her uc risk grubu icinde gozlenen ve beklenen mortalite oranlari arasinda dusuk risk grubunda anlamli fark saptanirken (p 0.05). Sonuc: EuroSCORE risk siniflamasinin belirli hasta grubunda literatur ile uyumlu sonuclar verdigini ve bu skorlama sisteminin bolgemizdeki KABG hasta populasyonunda preoperatif risk degerlendirmesi icin guvenilir olarak kullanilabilecegini soyleyebiliriz. Anahtar Sozcu¨kler: EuroSCORE; Ontario province risk; Parsonnet; Mortalite; Koroner arter baypas cerrahisi ABSTRACT Introduction: We aimed to compare the efficacy of three different well-known and commonly used mortality risk-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 Turkiye Yuksek Ihtisas Hospital Cardiovascular Surgery Clinic between January 2003 – December 2004 included in this study. The inhospital deaths and the deaths in postoperative 30 days were accepted as mortality. The patients were divided into low, moderate and high-risk groups as the risk scoring systems prerequisites. The predicted mortality rates 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 between the groups (p>0.05). The observed mortality rates of low and moderate risk groups were significantly lower than the predicted mortality rates with Parsonnet risk scoring system (p 0.05). The predicted mortality rates with Ontario Province Risk (OPR) scoring system and observed mortality rates in the low risk group were significantly different (p 0.05). Conclusion: The EuroSCORE risk scoring system results were similar to the results in the literature. It is a reliable way of risk prediction for the patients undergoing CABG surgery in our region. Keywords: EuroSCORE; Ontario province risk; Parsonnet; Mortality; Coronary artery bypass grafting