1
|
Di Bacco L, D’Alonzo M, Baudo M, Montisci A, Di Eusanio M, Folliguet T, Solinas M, Miceli A, Fischlein T, Rosati F, Muneretto C. Reliability of EuroSCORE II on Prediction of Thirty-Day Mortality and Long-Term Results in Patients Treated with Sutureless Valves. J Clin Med 2024; 13:3986. [PMID: 38999550 PMCID: PMC11242606 DOI: 10.3390/jcm13133986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/19/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
Background: EuroSCORE II (ES2) is a reliable tool for preoperative cardiac surgery mortality risk prediction; however, a patient's age, a surgical procedure's weight and the new devices available may cause its accuracy to drift. We sought to investigate ES2 performance related to the surgical risk and late mortality estimation in patients who underwent aortic valve replacement (AVR) with sutureless valves. Methods: Between 2012 and 2021, a total of 1126 patients with isolated aortic stenosis who underwent surgical AVR by means of sutureless valves were retrospectively collected from six European centers. Patients were stratified into three groups according to the EuroSCORE II risk classes (ES2 < 4%, ES2 4-8% and ES2 > 8%). The accuracy of ES2 in estimating mortality risk was assessed using the standardized mortality ratio (O/E ratio), ROC curves (AUC) and Hosmer-Lemeshow (HL) test for goodness-of-fit. Results: The overall observed mortality was 3.0% (predicted mortality ES2: 5.39%) with an observed/expected (O/E) ratio of 0.64 (confidential interval (CI): 0.49-0.89). In our population, ES2 showed a moderate discriminating power (AUC 0.65, 95%CI 0.56-0.72, p < 0.001; HL p = 0.798). Good accuracy was found in patients with ES2 < 4% (O/E ratio 0.54, 95%CI 0.23-1.20, AUC 0.75, p < 0.001, HL p = 0.999) and for patients with an age < 75 years (O/E ratio 0.98, 95%CI 0.45-1.96, AUC 0.76, p = 0.004, HL p = 0.762). Moderate discrimination was observed for ES2 in the estimation of long-term risk of mortality (AUC 0.64, 95%CI: 0.60-0.68, p < 0.001). Conclusions: EuroSCORE II showed good accuracy in patients with an age < 75 years and patients with ES2 < 4%, while overestimating risk in the other subgroups. A recalibration of the model should be taken into account based on the complexity of actual patients and impact of new technologies.
Collapse
Affiliation(s)
- Lorenzo Di Bacco
- Unit of Cardiac Surgery, Univesity of Brescia, 25123 Brescia, Italy; (L.D.B.); (A.M.); (F.R.); (C.M.)
| | - Michele D’Alonzo
- Unit of Cardiac Surgery, Univesity of Brescia, 25123 Brescia, Italy; (L.D.B.); (A.M.); (F.R.); (C.M.)
| | - Massimo Baudo
- Cardiothoracic Surgery, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA;
| | - Andrea Montisci
- Unit of Cardiac Surgery, Univesity of Brescia, 25123 Brescia, Italy; (L.D.B.); (A.M.); (F.R.); (C.M.)
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, 60121 Ancona, Italy;
| | - Thierry Folliguet
- Unit of Cardiac Surgery, Henri Mondor Hospital, 94010 Creteil, France;
| | - Marco Solinas
- Monasterio Foundation Heart Hospital, 54100 Massa, Italy;
| | - Antonio Miceli
- Department of Minimally Invasive Cardiac Surgery, Sant’Ambrogio Hospital, 20122 Milan, Italy;
| | - Theodor Fischlein
- Department of Cardiac Surgery, Paracelsus Medical University, 90419 Nuremberg, Germany;
| | - Fabrizio Rosati
- Unit of Cardiac Surgery, Univesity of Brescia, 25123 Brescia, Italy; (L.D.B.); (A.M.); (F.R.); (C.M.)
| | - Claudio Muneretto
- Unit of Cardiac Surgery, Univesity of Brescia, 25123 Brescia, Italy; (L.D.B.); (A.M.); (F.R.); (C.M.)
| |
Collapse
|
2
|
Jia T, Xu K, Bai Y, Lv M, Shan L, Li W, Zhang X, Li Z, Wang Z, Zhao X, Li M, Zhang Y. Machine-learning predictions for acute kidney injuries after coronary artery bypass grafting: a real-life muticenter retrospective cohort study. BMC Med Inform Decis Mak 2023; 23:270. [PMID: 37996844 PMCID: PMC10668365 DOI: 10.1186/s12911-023-02376-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) after coronary artery bypass grafting (CABG) surgery is associated with poor outcomes. The objective of this study was to apply a new machine learning (ML) method to establish prediction models of AKI after CABG. METHODS A total of 2,780 patients from two medical centers in East China who underwent primary isolated CABG were enrolled. The dataset was randomly divided for model training (80%) and model testing (20%). Four ML models based on LightGBM, Support vector machine (SVM), Softmax and random forest (RF) algorithms respectively were established in Python. A total of 2,051 patients from two other medical centers were assigned to an external validation group to verify the performances of the ML prediction models. The models were evaluated using the area under the receiver operating characteristics curve (AUC), Hosmer-Lemeshow goodness-of-fit statistic, Bland-Altman plots, and decision curve analysis. The outcome of the LightGBM model was interpreted using SHapley Additive exPlanations (SHAP). RESULTS The incidence of postoperative AKI in the modeling group was 13.4%. Similarly, the incidence of postoperative AKI of the two medical centers in the external validation group was 8.2% and 13.6% respectively. LightGBM performed the best in predicting, with an AUC of 0.8027 in internal validation group and 0.8798 and 0.7801 in the external validation group. The SHAP revealed the top 20 predictors of postoperative AKI ranked according to the importance, and the top three features on prediction were the serum creatinine in the first 24 h after operation, the last preoperative Scr level, and body surface area. CONCLUSION This study provides a LightGBM predictive model that can make accurate predictions for AKI after CABG surgery. The LightGBM model shows good predictive ability in both internal and external validation. It can help cardiac surgeons identify high-risk patients who may experience AKI after CABG surgery.
Collapse
Affiliation(s)
- Tianchen Jia
- College of Information Science, Shanghai Ocean University, Shanghai, P.R. China
| | - Kai Xu
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China
| | - Yun Bai
- College of Information Science, Shanghai Ocean University, Shanghai, P.R. China
| | - Mengwei Lv
- Department of Thoracic Surgery, Xuzhou Cancer Hospital, Xuzhou, P.R. China
| | - Lingtong Shan
- Department of Thoracic Surgery, Sheyang County People's Hospital, Yancheng, P.R. China
| | - Wei Li
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, 241 Huaihai West Road, Shanghai, 200120, China
| | - Xiaobin Zhang
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, 241 Huaihai West Road, Shanghai, 200120, China
| | - Zhi Li
- Department of Cardiovascular Surgery, Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing, P.R. China
| | - Zhenhua Wang
- College of Information Science, Shanghai Ocean University, Shanghai, P.R. China
| | - Xin Zhao
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China.
| | - Mingliang Li
- Department of Cardiovascular Surgery, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia, P.R. China.
| | - Yangyang Zhang
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, 241 Huaihai West Road, Shanghai, 200120, China.
| |
Collapse
|
3
|
Duan MX, Zhao X, Li SL, Tao JZ, Li BY, Meng XG, Dai DP, Lu YY, Yue ZZ, Du Y, Rui ZA, Pang S, Zhou YH, Miao GR, Bai LP, Zhang QY, Zhao XY. Analysis of influencing factors for prognosis of patients with ventricular septal perforation: A single-center retrospective study. Front Cardiovasc Med 2022; 9:995275. [DOI: 10.3389/fcvm.2022.995275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
BackgroundVentricular septal rupture (VSR) is a type of cardiac rupture, usually complicated by acute myocardial infarction (AMI), with a high mortality rate and often poor prognosis. The aim of our study was to investigate the factors influencing the long-term prognosis of patients with VSR from different aspects, comparing the evaluation performance of the Gensini score, Sequential Organ Failure Assessment (SOFA) score and European Heart Surgery Risk Assessment System II (EuroSCORE II) score systems.MethodsThis study retrospectively enrolled 188 patients with VSR between Dec 9, 2011 and Nov 21, 2021at the First Affiliated Hospital of Zhengzhou University. All patients were followed up until Jan 27, 2022 for clinical data, angiographic characteristics, echocardiogram outcomes, intraoperative, postoperative characteristics and major adverse cardiac events (MACEs) (30-day mortality, cardiac readmission). Cox proportional hazard regression analysis was used to explore the predictors of long-term mortality.ResultsThe median age of 188 VSR patients was 66.2 ± 9.1 years and 97 (51.6%) were males, and there were 103 (54.8%) patients in the medication group, 34 (18.1%) patients in the percutaneous transcatheter closure (TCC) group, and 51 (27.1%) patients in the surgical repair group. The average follow-up time was 857.4 days. The long-term mortality of the medically managed group, the percutaneous TCC group, and the surgical repair group was 94.2, 32.4, and 35.3%, respectively. Whether combined with cardiogenic shock (OR 0.023, 95% CI 0.001–0.054, P = 0.019), NT-pro BNP level (OR 0.027, 95% CI 0.002–0.34, P = 0.005), EuroSCORE II (OR 0.530, 95% CI 0.305–0.918, P = 0.024) and therapy group (OR 3.518, 95% CI 1.079–11.463, P = 0.037) were independently associated with long-term mortality in patients with VSR, and this seems to be independent of the therapy group. The mortality rate of surgical repair after 2 weeks of VSR was much lower than within 2 weeks (P = 0.025). The cut-off point of EuroSCORE II was determined to be 14, and there were statistically significant differences between the EuroSCORE II < 14 group and EuroSCORE II≥14 group (HR = 0.2596, 95%CI: 0.1800–0.3744, Logrank P < 0.001).ConclusionPatients with AMI combined with VSR have a poor prognosis if not treated surgically, surgical repair after 2 weeks of VSR is a better time. In addition, EuroSCORE II can be used as a scoring system to assess the prognosis of patients with VSR.
Collapse
|
4
|
Mastroiacovo G, Bonomi A, Ludergnani M, Franchi M, Maragna R, Pirola S, Baggiano A, Caglio A, Pontone G, Polvani G, Merlino L. Is EuroSCORE II still a reliable predictor for cardiac surgery mortality in 2022? A retrospective study study. Eur J Cardiothorac Surg 2022; 64:ezad294. [PMID: 37669150 PMCID: PMC10722878 DOI: 10.1093/ejcts/ezad294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 07/03/2023] [Accepted: 09/04/2023] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVES The European System for Cardiac Operation Risk Evaluation II (EuroSCORE II) is the most common tool used to evaluate the perioperative risk of mortality after cardiac surgery in Europe, and its use is currently recommended by the relevant guidelines. However, recently, its role has been questioned: Several papers have suggested that these algorithms may no longer be adequate for risk prediction due to an overestimation of adult cardiac surgical risk. Our goal was to validate the EuroSCORE II in the prediction of 30-day in-hospital mortality in patients undergoing open cardiac surgery in a high-volume hospital. METHODS In this retrospective cohort study, we included all patients who underwent cardiac surgery from January 2016 to May 2022 within the departments of cardiac surgery of the Monzino Cardiology Centre in Milan, Italy. We evaluated the discrimination power of the EuroSCORE II by using the receiver operating characteristic curve and the corresponding area under the curve. We performed calibration plots to assess the concordance between the model's prediction and the observed outcomes. RESULTS A total of 4,034 patients were included (mean age = 65.1 years; 68% males), of which 674 (16.7%) underwent isolated coronary artery bypass grafting. The EuroSCORE II showed a good discrimination power in predicting 30-day in-hospital mortality (area under the curve = 0.834). However, for interventions performed in an elective setting, very low values of the EuroSCORE II overestimated the observed mortality, whereas for interventions performed in an emergency setting, EuroSCORE II values above 10 extensively underestimated the observed mortality. CONCLUSIONS Our study suggests that the EuroSCORE II seems not to be a reliable score in estimating the true risk of death, especially in high-risk patients.
Collapse
Affiliation(s)
- Giorgio Mastroiacovo
- IRCCS Centro Cardiologico Monzino, Department of Cardiovascular Surgery, Milan, Italy
| | - Alice Bonomi
- Department of Statistics, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Monica Ludergnani
- Healthcare Management, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Matteo Franchi
- Department of Statistics, IRCCS Centro Cardiologico Monzino, Milan, Italy
- National Centre for Healthcare Research & Pharmacoepidemiology, Head Office at the Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Riccardo Maragna
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138, Milan, Italy
| | - Sergio Pirola
- IRCCS Centro Cardiologico Monzino, Department of Cardiovascular Surgery, Milan, Italy
| | - Andrea Baggiano
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138, Milan, Italy
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, 20122, Milan, Italy
| | - Alice Caglio
- Healthcare Management, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Gianluca Pontone
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138, Milan, Italy
| | - Gianluca Polvani
- IRCCS Centro Cardiologico Monzino, Department of Cardiovascular Surgery, Milan, Italy
- Department of Surgical and Dental Biomedical Sciences, University of Milan, Italy
| | - Luca Merlino
- Head of Healthcare Management, IRCCS Centro Cardiologico Monzino, Milan, Italy
| |
Collapse
|
5
|
Gao F, Shan L, Wang C, Meng X, Chen J, Han L, Zhang Y, Li Z. Predictive Ability of European Heart Surgery Risk Assessment System II (EuroSCORE II) and the Society of Thoracic Surgeons (STS) Score for in-Hospital and Medium-Term Mortality of Patients Undergoing Coronary Artery Bypass Grafting. Int J Gen Med 2021; 14:8509-8519. [PMID: 34824547 PMCID: PMC8610380 DOI: 10.2147/ijgm.s338819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/08/2021] [Indexed: 12/13/2022] Open
Abstract
Objective To evaluate the powers of European Heart Surgery Risk Assessment System II (EuroSCORE II) and the Society of Thoracic Surgeons (STS) score in predicting in-hospital and medium-term mortality of patients undergoing coronary artery bypass grafting (CABG). Methods Totally 1628 Chinese patients were included between January 2000 and January 2018. Their perioperative clinical data were collected and the patients were closely followed up. According to the length of follow-up time, the total cohort was divided into 1-year, 2-year, 3-year, 4-year and 5-year groups. The in-hospital and medium-term risk prediction of EuroSCORE II and STS score were comparatively assessed by calibration, discrimination, decision curve analysis (DCA), net reclassification index (NRI), integrated discrimination improvement (IDI) and Bland-Altman analysis. Results About 36 (2.21%) patients died during hospitalization. Both EuroSCORE II and STS score performed extremely well in predicting in-hospital mortality (area under curve = 0.900 and 0.879, respectively). However, calibration and discrimination analyses showed gradual decrease when these two risk evaluation systems were used to predict mortality during the follow-up period. At the same time, the predictive ability of EuroSCORE II was better than STS score. DCA curves showed that the performances of the two evaluation systems were roughly equal between the threshold probability of 0% to 20%. The percentage of correct reclassification of EuroSCORE II was 21.64% higher than that of STS score in predicting 2-year postoperative mortality. The IDI index showed that the predictive capabilities of these two systems were roughly equivalent. Bland-Altman analysis showed no significant difference between the values of the two systems. Conclusion EuroSCORE II and STS score have excellent predictive powers in predicting in-hospital mortality of patients undergoing CABG. In particular, EuroSCORE II is superior in calibration and discrimination. The prediction efficiency of the two risk evaluation systems is still acceptable for two-year postoperative mortality, but decreases year by year.
Collapse
Affiliation(s)
- Fei Gao
- Cardiovascular Department, Huaiyin Hospital of Huai'an City, Huai'an, Jiangsu, People's Republic of China
| | - Lingtong Shan
- Department of Thoracic Surgery, Sheyang County People's Hospital, Yancheng, Jiangsu, People's Republic of China
| | - Chong Wang
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Xiaoqi Meng
- The Second Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Jiapeng Chen
- Xinglin College, Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Lixiang Han
- Department of Cardiovascular Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Yangyang Zhang
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Zhi Li
- Department of Cardiovascular Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| |
Collapse
|
6
|
Taleb Bendiab T, Brusset A, Estagnasié P, Squara P, Nguyen LS. Performance of EuroSCORE II and Society of Thoracic Surgeons risk scores in elderly patients undergoing aortic valve replacement surgery. Arch Cardiovasc Dis 2021; 114:474-481. [PMID: 33558164 DOI: 10.1016/j.acvd.2020.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/02/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND In cardiac surgery, risk is estimated with models such as EuroSCORE II and the Society of Thoracic Surgeons (STS) score. Performance of these scores may vary across various patient age ranges. AIM To assess the effect of patient age on performance of the EuroSCORE II and STS scores, regarding postoperative mortality after surgical aortic valve replacement. METHODS In a prospective cohort of patients, we assessed risk stratification of EuroSCORE II and STS scores for discrimination of in-hospital mortality with the area under the receiver operating characteristic curve (AUROC) and calibration with the Hosmer-Lemeshow test. Two groups of patients were compared: elderly (aged>75years) and younger patients. RESULTS Of 1229 patients included, 635 (51.7%) were elderly. Mean EuroSCORE II score was 3.7±4.4% and mean STS score was 2.1±1.5%. Overall in-hospital mortality was 4.8% and was higher in the elderly compared with younger patients (6.6% vs. 2.8%; log-rank P=0.014). AUROC for the EuroSCORE II score was lower in elderly than in younger patients (0.731 vs. 0.784; P=0.025). Similarly, AUROC for the STS score was lower in elderly versus younger patients (0.738 vs. 0.768; P=0.017). In elderly patients, EuroSCORE II and STS scores were not adequately calibrated and significantly underestimated mortality. Age was independently associated with mortality, regardless of EuroSCORE II or STS score. CONCLUSIONS In this cohort, EuroSCORE II and STS scores did not perform as well in elderly patients as in younger patients. Elderly patients may be at increased postoperative risk, regardless of risk score.
Collapse
Affiliation(s)
- Tahar Taleb Bendiab
- Critical Care Medicine Department, CMC Ambroise-Paré, 92200 Neuilly-sur-Seine, France
| | - Alain Brusset
- Critical Care Medicine Department, CMC Ambroise-Paré, 92200 Neuilly-sur-Seine, France
| | - Philippe Estagnasié
- Critical Care Medicine Department, CMC Ambroise-Paré, 92200 Neuilly-sur-Seine, France
| | - Pierre Squara
- Critical Care Medicine Department, CMC Ambroise-Paré, 92200 Neuilly-sur-Seine, France
| | - Lee S Nguyen
- Critical Care Medicine Department, CMC Ambroise-Paré, 92200 Neuilly-sur-Seine, France.
| |
Collapse
|
7
|
Li X, Shan L, Lv M, Li Z, Han C, Liu B, Ge W, Zhang Y. Predictive ability of EuroSCORE II integrating cardiactroponin T in patients undergoing OPCABG. BMC Cardiovasc Disord 2020; 20:463. [PMID: 33115418 PMCID: PMC7594339 DOI: 10.1186/s12872-020-01745-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/18/2020] [Indexed: 12/14/2022] Open
Abstract
Background Preoperative risk evaluation systems are significant and important to the allocation of medical resources and the communication between doctors and patients. The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is widely used in clinical practice. Cardiac troponin T (cTnT) can specifically and accurately reflect myocardial injury. Whether EuroSCORE II can improve the predictive power after integrating with cTnT is still unclear. This study was a retrospective single center study designed to assess the predictive ability of EuroSCORE II integrated with cTnT for patients undergoing isolated off-pump coronary artery bypass grafting (OPCABG). Methods This retrospective and observational cohort study included 1887 patients who underwent first isolated OPCABG. cTnT was detected within 48 h before operation in each patient. According to myocardial injury, patients were divided by cTnT into 4 stages. A new risk evaluation system was created through logistic regression with EuroSCORE II and myocardial injury classification as covariates. Then the two risk evaluation systems were comparatively assessed by regression analysis, receiver operator characteristic curves, net reclassification index, Bland–Altman plots and decision curve analysis. Results There were 43 in-hospital deaths, with a mortality of 2.30% (43/1887). The logistic regression analysis showed that preoperative myocardial injury classification was a significant risk factor for in-hospital mortality in both total cohort (OR 1.491, 95%CI 1.049–2.119) and subsets (OR 1.761, 95%CI 1.102–2.814). The new risk evaluation system has higher calibration and discrimination power than EuroSCORE II, both for overall cohort and subsets. Especially, the new system has obvious advantages in discrimination power in the subset of acute myocardial infarction (AUC 0.813 vs. 0.772, 0.906 vs. 0.841, and 0.715 vs. 0.646, respectively). Conclusions Both myocardial injury classification and EuroSCORE II are independent risk factors of in-hospital mortality in OPCABG patients. The new risk evaluation system has higher predictive ability than EuroSCORE II, especially in patients with a recent history of AMI.
Collapse
Affiliation(s)
- Xiang Li
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, People's Republic of China
| | - Lingtong Shan
- Department of Thoracic Surgery, Sheyang County People's Hospital, Yancheng, Jiangsu, People's Republic of China.,Department of Thoracic Surgery, Yancheng Third People's Hospital, The Affiliated Yancheng Hospital of Southeast University Medical College, Yancheng, Jiangsu, People's Republic of China
| | - Mengwei Lv
- Shanghai East Hospital of Clinical Medical College, Nanjing Medical University, Shanghai, People's Republic of China.,Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, People's Republic of China
| | - Zhi Li
- Department of Cardiovascular Surgery, Jiangsu Province Hospital, The First Affiliated Hospital With Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Chunyan Han
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No.301 Central Yanchang Road, Shanghai, 200072, People's Republic of China
| | - Ban Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No.301 Central Yanchang Road, Shanghai, 200072, People's Republic of China.
| | - Wen Ge
- Department of Cardiothoracic Surgery, Shuguang Hospital, Affiliated to Shanghai University of TCM, Shanghai, People's Republic of China.
| | - Yangyang Zhang
- Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, People's Republic of China.
| |
Collapse
|
8
|
Subramani S. The current status of EuroSCORE II in predicting operative mortality following cardiac surgery. Ann Card Anaesth 2020; 23:256-257. [PMID: 32687077 PMCID: PMC7559946 DOI: 10.4103/aca.aca_32_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
|
9
|
Li Z, Ge W, Han C, Lv M, He Y, Su J, Liu B, Zhang Y. Prognostic Values of Three Equations in Estimating Glomerular Filtration Rates of Patients Undergoing Off-Pump Coronary Artery Bypass Grafting. Ther Clin Risk Manag 2020; 16:451-459. [PMID: 32547042 PMCID: PMC7247602 DOI: 10.2147/tcrm.s248710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/17/2020] [Indexed: 11/23/2022] Open
Abstract
Background Renal dysfunction is independently associated with both short-term and long-term mortality after coronary artery bypass grafting (CABG). The estimated glomerular filtration rate (eGFR) is a convenient and effective indicator of renal function. However, the ability of eGFR calculated by various equations to predict the outcomes of patients undergoing off-pump CABG (OPCABG) is still unclear. This study was aimed to compare the predictive ability of in-hospital and long-term mortality in three equations of estimating renal functions after OPCABG. Methods Totally, 1362 patients undergoing OPCABG were retrospectively reviewed. Preoperative and postoperative serum creatinine (Scr) levels were detected. The renal function was evaluated by the Cockcroft-Gault (CG) equation, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, and the full-age spectrum (FAS) equation. The endpoints were in-hospital and long-term all-cause mortality rates. Receiver operating characteristic curves, net reclassification index, decision curve analysis (DCA), multivariable logistic model, and Cox regression model were used for comparisons. Results The CG equation had the significantly highest discriminatory power to predict in-hospital mortality (area under the curve=0.815). Valuable clinical net benefits of the CG equation were greater than the other two equations regardless of before or after operation by DCA. Multivariable logistic and Cox regression analysis illustrated that the eGFR calculated by the CG equation was a significant independent risk factor of both in-hospital mortality (odds ratio=3.390) and long-term mortality (hazard ratio=1.553). Conclusion The CG equation outperformed the FAS and CKD-EPI equations in predicting the mortality of patients after OPCABG. Postoperative renal function was more efficiently predicted compared with the preoperative one.
Collapse
Affiliation(s)
- Zhi Li
- Department of Cardiovascular Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Wen Ge
- Department of Thoracic and Cardiovascular Surgery, Shuguang Hospital, Shanghai University of TCM, Shanghai, People's Republic of China
| | - Chunyan Han
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Mengwei Lv
- Shanghai East Hospital of Clinical Medicine College, Nanjing Medical University, Shanghai, People's Republic of China.,Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yanzhong He
- Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Juntao Su
- Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Ban Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yangyang Zhang
- Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| |
Collapse
|
10
|
Yu S, Zhang W, Wang L, Li Z, Li Q, Lv M, Liu B, Zhang Y. Effectiveness of Saphenous Vein Y-Grafts in Patients Undergoing Off-Pump Complete Myocardial Revascularization. Med Sci Monit 2019; 25:598-604. [PMID: 30662058 PMCID: PMC6350452 DOI: 10.12659/msm.911981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate perioperative and mid-term outcomes of saphenous vein Y-grafts in patients with multi-vessel coronary artery disease. Material/Methods Sixty patients who underwent off-pump coronary surgery with Y-graft between 2005 and 2016 were enrolled, including 38 patients with natural Y-graft. Sixty patients with multi-vessel lesions in the same period were randomly selected as a control group. Results A total of 484 conduits were employed. The intraoperative variables were insignificantly different between groups, but Y-graft group compared with control group had more grafts (4.2±0.84 vs. 3.87±0.85) and anastomoses (6.30±1.39 vs. 5.62±1.15). No patient died during coronary artery bypass grafting and no episode of perioperative myocardial infarction was found. Follow-up duration lasted from 1 to 137 (40.0±27.7) months. No significant difference between Y-graft group and control group was found in Kaplan-Meier 3-year survival rate (93.4% vs. 88.0%) or 5-year survival rate (81.4% vs. 88.0%). Conclusions Saphenous vein Y-graft is a feasible and safe revascularization strategy for multi-vessel coronary artery disease patients and brings about satisfactory outcomes.
Collapse
Affiliation(s)
- Shuai Yu
- Key Laboratory of Arrhythmias of the Ministry of Education of China, East Hospital, Tongji University School of Medicine, Shanghai, China (mainland).,Heart Health Center, East Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Weiran Zhang
- Department of Cardiothoracic Surgery, BenQ Hospital, Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Luxin Wang
- Key Laboratory of Arrhythmias of the Ministry of Education of China, East Hospital, Tongji University School of Medicine, Shanghai, China (mainland).,Shanghai East Hospital of Clinical Medical College, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Zhi Li
- Department of Cardiothoracic Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Qifan Li
- Department of Cardiothoracic Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Mengwei Lv
- Shanghai East Hospital of Clinical Medical College, Nanjing Medical University, Nanjing, Jiangsu, China (mainland).,Department of Cardiovascular Surgery, East Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Ban Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Yangyang Zhang
- Key Laboratory of Arrhythmias of the Ministry of Education of China, East Hospital, Tongji University School of Medicine, Shanghai, China (mainland).,Department of Cardiovascular Surgery, East Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| |
Collapse
|
11
|
Czub P, Cacko A, Gawałko M, Tataj E, Poliński J, Pawlik K, Cichoń R, Hendzel P. Perioperative risk assessment with Euroscore and Euroscore II in patients with coronary artery or valvular disease. Medicine (Baltimore) 2018; 97:e13572. [PMID: 30558022 PMCID: PMC6320047 DOI: 10.1097/md.0000000000013572] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Nowadays, both the European System for Cardiac Operative Risk Evaluation (EuroSCORE) logistic (ESL) and EuroSCORE II (ESII) models are used worldwide in predicting in-hospital mortality after cardiac operation. However, these scales are based on different populations and represent different medical approaches. The aim of the study was to assess the effectiveness of the ESL and the ESII risk scores in predicting in-hospital death and prolonged hospitalization in intensive care unit (ICU) after coronary artery bypass grafting (CABG), aortic valve replacement (AVR), and mitral valve replacement (MVR) by comparison of an estimated risk and a real-life observation at a reference cardiac surgery unit.This retrospective study was based on medical records of patients who underwent a CABG, AVR, or MVR at a reference cardiac surgery unit in a 2-year period. Primary endpoint was defined as in-hospital death. Secondary endpoint was a prolonged hospitalization at the ICU, defined as longer than 3 days.The study encompassed 586 patients [114 (23.1%) female, mean age 65.8 ± 10.5 years], including 493 patients undergoing CABG, 66 patients undergoing AVR, and 27 patients undergoing MVR. The ESL and ESII risk scores were higher in MVR subgroup (31.7% ± 30.5% and 15.3% ± 19.4%) and AVR subgroup (9.7% ± 11.6% and 3.2% ± 4.2%) than in CABG subgroup (6.9% ± 10.4% and 2.5% ± 4.1%; P < .001). Subgroups of patients were significantly different in terms of clinical, biochemical, and echocardiography factors. Primary endpoint occurred in 36 (6.1%) patients: 21 (4.3%), 7 (10.6%), and 8 (29.7%) in CABG, AVR, and MVR subgroups, respectively. The ESII underestimated the risk of mortality. Secondary endpoint occurred in 210 (35.8%) patients: 172 (34.9%), 22 (33.4%), and 16 (59.3%) in CABG, AVR, and MVR subgroups, respectively.In the study, the perioperative risk estimated with the ESL and the ESII risk scores was compared with a real-life outcome among over 500 patients. Regardless of the type of surgery, result in the ESL was better correlated with the risk of in-hospital death.
Collapse
Affiliation(s)
| | | | - Monika Gawałko
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | | | | | | | | |
Collapse
|