Prognostic value of preoperative quality of life on mortality after isolated elective myocardial revascularization

Abstract

OBJECTIVES This study evaluates whether a low preoperative quality of life (QoL), measured with the EuroQoL instruments EQ-5D and EQ-visual analogue scale (VAS) can be used as a predictor of mortality after elective isolated myocardial revascularization. METHODS A total of 2501 patients, with a mean age of 65.3 +/- 9.4 (range 18-93) years and a mean additive EuroSCORE of 2.7 +/- 2.1 (0-12), undergoing an elective isolated coronary artery bypass graft between January 2002 and June 2011 completed preoperative EQ-5D and EQ-VAS. RESULTS Hospital mortality [1.0% (25/2501 patients)] and 30-day mortality [1.2% (29/25 patients)] were the studied outcomes. The EQ-5D was 0.69 +/- 0.26 (-0.30 to 1.0) with a median of 0.77 and the EQ-VAS was 59.7 +/- 22.4 (0-100) with a median of 60. Regression analysis showed a significant correlation between hospital mortality and EQ-5D (P = 0.016) and EQ-VAS (P = 0.033). There is a significant correlation between 30-day mortality and EQ-5D (P = 0.048), but not for EQ-VAS (P = 0.06). The c-statistics (95% confidence interval) for EQ-5D and EQ-VAS for predicting hospital mortality are 0.36 (0.24-0.46) and 0.33 (0.23-0.42), respectively. The c-statistics for predicting 30-day mortality are 0.39 (0.30-0.49) for EQ-5D and 0.35 (0.26-0.44) for EQ-VAS. CONCLUSIONS Based on these results, we conclude that, in isolation, poor low preoperative EQ-5D and EQ-VAS scores do not contribute to deciding which patients should undergo cardiac surgery.