In Nordic countries 30-day mortality rate is half that estimated with EuroSCORE II in high-risk adult patients given aprotinin and undergoing mainly complex cardiac procedures

Figures & data

Table 1. Pre-, intra- and postoperative variables in adult patients exposed to aprotinin during cardiac surgery with cardiopulmonary bypass.

Countries	Nordic	Other European#
N	486	4823
Male	356 (73.3%)	3639 (75.5%)”
Age (years, mean ± SD)	59.8 ± 14.6	62.6 ± 14.8**
>75 years	48 (9.9%)	955 (19.8%)*
Isolated(i) CABG (on-label)	59 (12.1%)	1304 (27.1%)**
Other types of surgery than iCABG	427 (87.9%)	3519 (72.9%)**
Surgery for endocarditis	175 (36.0%)	420 (8.7%)**
Surgery for aortic dissection	81 (16.7%)	579 (12.1%)**
Full Hammersmith regime	437 (89.9%)	2820 (50.2%)**
Previous heart operation	180 (37.0%)	1474 (30.6%)”
Dual antiplatelet treatment (DAPT)	73 (15.0%)	437 (9.1%)*
DAPT in iCABG	43 (72.9%)	257 (18.9%)**
Preop. renal impairment	248 (51.0%)	2420 (50.2%)”
Procedure
Elective	127 (26.1%)	2632 (54.6%)**
Urgent	252 (51.9%)	1315 (27.3%)**
Emergent	83 (17.1%)	813 (16.9%)”
Salvage	24 (4.9%)	58 (1.2%)**
CPB minutes (mean ± SD)	159 ± 80	145 ± 88.8**
Re-exploration for bleeding	31 (6.4%)	253 (5.4%)”
Anaphylactic reactions	3 (0.6%)	9 (0.2%)”
In hospital mortality (death at discharge)	24 (4.9%)	311 (6.7%)”
Postoperative thromboembolic events	23 (4.7%)	284 (6.1%)”
Permanent stroke	15 (3.1%)	115 (2.5%)”
Myocardial infarction	5 (1.0%)	35 (0.7%)”
AKI	81 (16.7%)	543 (11.7%)**
New dialysis - any reason	68 (14.0%)	363 (8.0%)**

AKI: acute kidney injury: AKI was defined by pre-operative to postoperative rise in plasma creatinine level > 44 mmol/L (0.5 mg/dL); SD = standard deviation; * = p < .05; ** = p < .01;” = not significant, # = reference 16.

Table 2. Pre-, intra- and postoperative variables in adult patients exposed to aprotinin during cardiac surgery with cardio-pulmonary bypass other than isolated coronary artery bypass surgery.

Countries	Nordic	Other European
N	427	3519
Male	28 (65.6%)	2365 (67.3%)”
Age (years, mean ± SD)	59.0 ± 15.0	62.6 ± 14.8**
>75 years	44 (10.3%)	679 (19.3%)**
Surgery for endocarditis	175 (41.0%)	420 (11.9%)**
Surgery for aortic dissection	81 (19.0%)	579 (12.1%)**
Full Hammersmith regime	380 (89.0%)	2440 (69.4%)**
Previous heart operation	169 (39.6%)	1416 (40.3%)”
Dual antiplatelet treatment	9 (2.1%)	171 (4.9%)”
Preop. renal impairment	217 (50.8%)	1938 (55.7%)”
Procedure
Elective	121 (28.3%)	1840 (52.3%)**
Urgent	216 (50.6%)	922 (26.2%)**
Emergent	67 (15.8%)	701 (20.0%)*
Salvage	23 (5.4%)	53 (1.5%)**
CPB minutes (mean ± SD)	169 ± 79.2	145 ± 88.8**
Re-exploration for bleeding	29 (6.8%)	220 (6.3%)”
Anaphylactic reactions	0 (0.0%)	8 (0.2%)”
In hospital mortality (death at discharge)	21 (4.9%)	297 (8.7%)**
Postoperative thromboembolic events	21 (4.9%)	255 (7.5%)*
Permanent stroke	14 (3.3%)	105 (3.1%)”
Myocardial infarction	4 (0.9%)	24 (0.7%)”
AKI	72 (16.9%)	204 (5.3%)**
New dialysis - any reason	68 (15.9%)	341 (10.3%)**
Postoperative use of aminoglycosides	56 (13.1%)	1076 (31.3%)**
Pre- and postoperative use of aminoglycosides or/and one preoperative dose of teicoplanin	203 (47.5%)**^&

AKI = acute kidney injury: AKI was defined by pre-operative to postoperative rise in plasma creatinine level > 44 mmol/L (0.5 mg/dL); SD = standard deviation; * = p < 0.05; ** = p < 0.01; ” = not significant, ^& = when compared with postoperative use of aminoglycosides in European countries other than Nordic countries.

Figure 1. 30-day mortality rates (mean ± 95% confidence interval) for (a) all patients undergoing non-iCABG, (b) aortic dissection surgery, and (c) surgery for endocarditis, respectively, in comparison with corresponding estimated 30-day mortality rates according to EuroSCORE II.