Comparison of 19 pre-operative risk stratification models in open-heart surgery.

Department of Cardiothoracic Surgery, Heart and Lung Centre, Lund University Hospital, Sweden.
European Heart Journal (Impact Factor: 14.72). 05/2006; 27(7):867-74. DOI: 10.1093/eurheartj/ehi720
Source: PubMed

ABSTRACT To compare 19 risk score algorithms with regard to their validity to predict 30-day and 1-year mortality after cardiac surgery.
Risk factors for patients undergoing heart surgery between 1996 and 2001 at a single centre were prospectively collected. Receiver operating characteristics (ROC) curves were used to describe the performance and accuracy. Survival at 1 year and cause of death were obtained in all cases. The study included 6222 cardiac surgical procedures. Actual mortality was 2.9% at 30 days and 6.1% at 1 year. Discriminatory power for 30-day and 1-year mortality in cardiac surgery was highest for logistic (0.84 and 0.77) and additive (0.84 and 0.77) European System for Cardiac Operative Risk Evaluation (EuroSCORE) algorithms, followed by Cleveland Clinic (0.82 and 0.76) and Magovern (0.82 and 0.76) scoring systems. None of the other 15 risk algorithms had a significantly better discriminatory power than these four. In coronary artery bypass grafting (CABG)-only surgery, EuroSCORE followed by New York State (NYS) and Cleveland Clinic risk score showed the highest discriminatory power for 30-day and 1-year mortality.
EuroSCORE, Cleveland Clinic, and Magovern risk algorithms showed superior performance and accuracy in open-heart surgery, and EuroSCORE, NYS, and Cleveland Clinic in CABG-only surgery. Although the models were originally designed to predict early mortality, the 1-year mortality prediction was also reasonably accurate.

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    ABSTRACT: Background: Postoperative pulmonary complications (PPCs) are among the most frequently reported complications of Coronary Artery Bypass Graft (CABG) surgery. However, the risk to develop a PPC is not the same for all patients. The aim of this study was to validate a previously developed preoperative six-factor pulmonary risk model (age>70 years; productive cough, smoking, diabetes mellitus, inspiratory vital capacity > 75% predicted and maximum expiratory mouth pressure>75% predicted) to predict pneumonia, in patients undergoing CABG surgery. Methods: Prospectively collected data for 421 adult patients who had undergone elective CABG surgery, in a university medical center in the Netherlands, were used to validate the preoperative risk model for predicting pneumonia. The accuracy of the model was tested by comparing the expected and observed incidence of pneumonia in each patient. Results: Of the 421 patients, 227 (54%) were classified as being at high pulmonary risk, 24 (11%) of whom developed pneumonia. Only 4 of the 194 (2%) patients classified as being at low pulmonary risk developed pneumonia (OR=5.6; 95%CI, 1.9 to 16.5). The sensitivity (SE) was equal to 0.86, at a specificity (SP) of 0.48, both close to the values calculated for the development sample (SE=0.87, SP=0.56). The negative predictive value (NPV) was 0.98 and the area under curve (AUC) of the receiver-operating characteristics (ROC) curve was 0.76. The model that includes only the four anamnestic risk factors (age≥ 70 year, productive cough, smoking and diabetes mellitus) had an AUC equal to 0.75, with a SE=0.75, SP=0.62, and NPV=0.97. Conclusion: The study confirms the diagnostic accuracy of the preoperative six-factor pulmonary risk model in an independent sample. Both the six-factor and even the simple anamnestic four-factor models are accurate in identifying preoperative patients at risk of developing pneumonia undergoing CABG surgery.
    Journal Novel Physiotherapies. 01/2014; 4(4):1-6.
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    ABSTRACT: Different risk models have been introduced and refined in the past in order to improve standards of care. However, the predictive power of any risk algorithms can decline over time due to changes in surgical practice and the population's risk profile. The present study aimed to develop and validate a risk model for predicting operative mortality in patients with ischaemic heart failure (HF) undergoing surgical ventricular reconstruction (SVR). The study population included 525 patients with previous myocardial infarction and left ventricular remodelling referred to our centre for SVR. All patients underwent surgical reshaping; coronary artery bypass grafting was performed in 489 (93%) patients and mitral valve (MV) repair in 142 (27%). Operative mortality was defined as death within 30 days after surgery. All patients received an operative risk assessment using the logistic EuroSCORE and the ACEF score. Better accuracy was achieved by the ACEF score (0.771) compared with the EuroSCORE (0.747). On multivariable logistic regression analysis, forcing the ACEF score in the model, three additional factors remained as independent predictors of operative mortality: atrial fibrillation, NYHA Class 3-4 and MV surgery (odds ratio 2.2, 2.6 and 2.1, respectively) and were computed in the ACEF-SVR. The ACEF-SVR score demonstrated an improved accuracy in respect of the ACEF score (from 0.771 to 0.792) and a better calibration (Hosmer-Lemeshow χ(2) of 5.40, P = 0.714). The ACEF-SVR score, starting from a simplified model of risk enabled improvement in the accuracy and calibration of the model, tailoring the risk to a specific population of patients with HF undergoing a specific surgical procedure. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 02/2015; · 2.40 Impact Factor
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    ABSTRACT: Objective To evaluate the performance of the EuroSCORE II (ESII) and the Society of Thoracic Surgeons (STS) scores in surgical (SAVR) or transcatheter aortic valve replacement (TAVR). Design Systematic review of the literature and meta-analysis. Setting University hospitals. Participants Studies reporting data on the performance of ESII and STS scores in patients undergoing SAVR or TAVR. Interventions SAVR or TAVR. Measurements and Main Results Ten studies validated these scores in 13,856 patients who underwent either TAVR or SAVR. Operative mortality was 5.9% (SAVR 3.1%; TAVR 9.6%). ESII-expected mortality was 5.1% (O/E ratio: 1.15, SAVR, O/E ratio 0.94; TAVR, O/E ratio 1.23) and STS-expected mortality was 6.3% (O/E ratio: 0.94, SAVR, O/E ratio 0.84; TAVR, O/E ratio 1.13). The area under the ROC curve for ESII was 0.70 and for STS was 0.70 (SAVR patients: 0.73 for ESII and 0.75 for STS; TAVR patients; 0.66 for ESII and 0.63 for STS). The difference between observed/expected mortality was not significant for ESII (Peto’s OR 0.99, p = 0.88) and was significant for STS (Peto’s OR 0.86, p = 0.008). ESII (Peto’s OR 1.35, p<0.00001) and STS (Peto’s OR 1.23, p<0.00001) significantly underestimated the mortality risk in TAVR patients. The STS (Peto’s OR 0.74, p<0.0001) and, to a lesser extent, the ESII (Peto’s OR 0.86, p = 0.0.04) overestimated the mortality risk in SAVR patients. Conclusions The ESII and STS scores have good O/E ratios for either TAVR or SAVR patients, but both scores significantly underpredicted the risk of TAVR patients. ESII seemed to be accurate in predicting the risk of SAVR patients.
    Journal of Cardiothoracic and Vascular Anesthesia 09/2014; · 1.48 Impact Factor


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