Vasoactive inotropic score as a predictor of long-term mortality in patients after off-pump coronary artery bypass grafting

Abstract

Increased vasoactive-inotropic score (VIS) is a reliable predictor of mortality and morbidity after cardiac surgery. Here, we retrospectively evaluated the association between VIS and adverse outcomes in adult patients after off-pump coronary artery bypass grafting (OPCAB). We included 2149 patients who underwent OPCAB. The maximal VIS was calculated for the initial 48 postoperative hours using standard formulae. The primary outcome was 1-year death. The composite adverse outcome was death, resuscitation or mechanical support, myocardial infarction, revascularization, new-onset atrial fibrillation, infection requiring antibacterial therapy, acute kidney injury, and stroke. Path-analysis was conducted using lactate and prognostic nutritional index (PNI). VIS was associated with 1-year death (odds ratio [OR] 1.07 [1.04–1.10], p < 0.001) and 1-year composite outcome (OR 1.02 [1.0–1.03], p = 0.008). In path-analysis, high VIS showed a direct effect on the increased risk of 1-year death and composite outcome. In the pathway using lactate as a mediating variable, VIS showed an indirect effect on the composite outcome but no significant effect on death. Low PNI directly affected the increased risk of 1-year death and composite outcome, and had an indirect effect on both outcomes, even when VIS was used as a mediating variable. In patients undergoing OPCAB, high VIS independently predicted morbidity and 1-year death. Patients with increased lactate levels following high VIS had an increased risk of postoperative complications, although not necessarily resulting in death. However, patients with poor preoperative nutritional status had an increased risk of unfavourable outcomes, including death, implying the importance of preoperative nutritional support.

Effect of Esmolol Cardioplegia on Inotropic Support and Inotropic Score After Coronary Artery Bypass Surgery

“…In addition, if added to the cardioplegic solution, esmolol may provide additional protection by reducing myocardial activity [19][20][21] . Over the years, meta-analyses of randomized trials [23,[30][31][32][33][34] have been performed, which have confirmed that if esmolol is administered during a cardiac surgery, the rate of perioperative myocardial ischemia, occurrence of arrhythmias after CABG, as well as a reduced need for inotropic support in the postoperative period is reduced.…”

“…Vasoactive inotropic score (VIS) was calculated for each patient according to the following formula: (Dobutamine dose (µg/kg/min) + Dopamine dose (µg/kg/min) + Epinephrine dose (µg/kg/min x100) + Norepinephrine (µg/kg/min x100) ++ Enoximone dose (µg/kg/ min) during the operation itself, as well as in the postoperative period [31,32,33,34] .…”

Prognostic nutritional index and prognosis of patients with coronary artery disease: A systematic review and meta-analysis

“…The inclusion criteria of the studies included either acute coronary syndrome (ACS), mix of ACS and chronic coronary syndrome (CCS), or MI. Majority studies included patients undergoing PCI while two studies ( 16 , 26 ) included only CABG patients. In one study ( 29 ) the patients were managed by either PCI or CABG while in another ( 30 ) PCI or medical management was undertaken.…”

“…PNI was initially described to check the nutritional status of gastrointestinal surgery, but over the years it has been recognized as an important prognostic factor in several cancers (11)(12)(13). Over the past years, many studies have also used PNI to predict prognosis of CAD patients but with inconsistent results (14)(15)(16)(17)(18). However, no systematic review has been attempted to summarize the available evidence.…”

Comparison of vasoactive-inotropic score, vasoactive-ventilation-renal score, and modified vasoactive-ventilation-renal score for predicting the poor prognosis after coronary artery bypass grafting

“…In our study, M-VVR was confirmed to be positively associated with the poor prognosis of patients undergoing CABG. Previous studies have reported the positive association between VIS and poor prognosis in cardiac surgery [ 9 , 27 ]. Kwon et al manifested that increased postoperative VIS was independently correlated with the risk of 1-year mortality after CABG in adults [ 27 ].…”