High vasoactive-inotropic score is associated with poor outcomes in patients undergoing coronary artery bypass grafting: A systematic review and meta-analysis

Abstract

BackgroundVasoactive-inotropic score (VIS) has been previously utilized as one of the predictors in open heart procedures postoperatively, but its association with poor outcomes in patients who underwent coronary artery bypass graft (CABG) is still unclear. We aim to find the association in this population.MethodsPubMed, Google Scholar, and Scopus were systematically searched for studies showing an association of poor cardiovascular (CV) outcomes, including mortality with VIS from inception to May 2024 following CABG surgery. Pooled effect sizes (aOR, OR, and ROC AUC) were estimated using CMA version 4 with a fixed-effect model and 95% confidence intervals (CI). I2-Statistic was used to measure heterogeneity. Leave-one-out sensitivity analysis and meta-regression analysis were utilized to measure the robustness of our findings and detect influencing confounding variables, respectively. Quality assessment of the studies was done through the Joanna Briggs Institute (JBI) tool. p-value <0.05 was considered significant.ResultsSix studies with a total sample size of 6504 patients following CABG surgery, with a mean age of 63.6 ± 3.15 years, containing predominantly males (71.8%) reported poor outcomes such as CV morbidity, cardiopulmonary resuscitation, mechanical ventilation, stroke, and mortality. Most studies had hypertension, diabetes, and chronic kidney disease as comorbidities. VIS greater than 5 is validated by pooled ROC AUC of 80.1% [95% CI: 73.5-85.4]. Our meta-analysis found a significant association between VIS >5 and poor outcomes, including mortality in six studies with pooled unadjusted OR-1.08 [95% CI: 1.06-1.10, p < 0.0001] and in four studies with adjusted OR-1.07 [95% CI: 1.04-1.09, p < .0001] among those who underwent CABG. Sensitivity analysis showed no variations among studies and confirmed the robustness of our findings. Additionally, meta-regression analysis indicated that mean age was associated with a minimal progression rate of mortality in patients succeeding CABG with a VIS > 5 (p = .04). High scores in the JBI tool revealed high quality among the studies selected.ConclusionOur study suggests a significant association of VIS > 5 with poor cardiovascular outcomes in patients following CABG surgery. This association can help in predicting deleterious cardiovascular outcomes.

Keywords: Coronary Artery Bypass Grafting; Vasoactive Inotropic Score; cardiac arrest; inotrope drugs; morbidity; mortality; perioperative; poor outcomes; postoperative; vasoactive drugs.