加拿大非体外循环和体外循环冠状动脉搭桥手术的早期死亡率：胸外科医师协会（STS）和欧洲心脏手术风险评估系统（EuroSCORE）风险预测算法的比较
Early mortality from off-pump and on-pump coronary bypass surgery in Canada: a comparison of the STS and the EuroSCORE risk prediction algorithms.
作者信息
Farrokhyar Forough, Wang Xiaoyin, Kent Rosanne, Lamy Andre
机构信息
McMaster University, Hamilton, Canada.
出版信息
Can J Cardiol. 2007 Sep;23(11):879-83. doi: 10.1016/s0828-282x(07)70843-7.
OBJECTIVE
Early mortality from off-pump and on-pump coronary artery bypass graft (CABG) surgery was assessed and compared with two widely used risk algorithms for CABG: The Society of Thoracic Surgeons (STS) and the European System for Cardiac Operative Risk Evaluation (EuroSCORE).
METHOD
From March 12, 2001, to December 31, 2002, 1657 consecutive patients were treated with off-pump CABG and 1693 consecutive patients were treated with on-pump CABG. The predicted risk of mortality scores for the STS and EuroSCORE models were calculated. The predictive accuracy for early mortality was assessed by comparing the observed and expected mortalities for equal-sized quantiles of risk using the Hosmer-Lemeshow goodness-of-fit test. The discriminatory power of the models was evaluated by calculating the area under the receiver operating characteristic (ROC) curves.
RESULTS
The observed postoperative mortality was 1.8% (95% CI 1.3% to 2.4%) for off-pump CABG and 1.5% (95% CI 1.1% to 2.1%) for on-pump CABG. For both on-pump and off-pump CABG surgery, the Hosmer-Lemeshow goodness-of-fit test indicated good accuracy. The area under the ROC curve was 0.81 (95% CI 0.73 to 0.90) for the STS and 0.79 (95% CI 0.71 to 0.88) for EuroSCORE in off-pump CABG (P=0.567). The area under the ROC curve was 0.82 (95% CI 0.73 to 0.91) for STS and 0.81 (95% CI 0.71 to 0.90) for EuroSCORE in on-pump CABG (P=0.616). The STS-predicted risk of stroke, prolonged ventilation and renal failure were similar to the observed data, with relatively good discriminatory powers for both off-pump and on-pump CABG.
CONCLUSION
Both the STS and EuroSCORE risk algorithms are good predictors of early mortality from off-pump or on-pump CABG surgery. However, the generalizability of these results in the Canadian context would require a broader sampling of Canadian centres, including ones that provide both on-pump and off-pump CABG.
目的
评估非体外循环和体外循环冠状动脉旁路移植术（CABG）手术的早期死亡率，并与两种广泛使用的CABG风险算法进行比较：胸外科医师协会（STS）和欧洲心脏手术风险评估系统（EuroSCORE）。
方法
从2001年3月12日至2002年12月31日，1657例连续患者接受了非体外循环CABG治疗，1693例连续患者接受了体外循环CABG治疗。计算了STS和EuroSCORE模型的预测死亡风险评分。使用Hosmer-Lemeshow拟合优度检验，通过比较相同风险分位数的观察死亡率和预期死亡率，评估早期死亡率的预测准确性。通过计算受试者工作特征（ROC）曲线下的面积来评估模型的鉴别力。
结果
非体外循环CABG术后观察到的死亡率为1.8%（95%CI 1.3%至2.4%），体外循环CABG为1.5%（95%CI 1.1%至2.1%）。对于体外循环和非体外循环CABG手术，Hosmer-Lemeshow拟合优度检验均显示出良好的准确性。在非体外循环CABG中，STS的ROC曲线下面积为0.81（95%CI 0.73至0.90），EuroSCORE为0.79（95%CI 0.71至0.88）（P=0.567）。在体外循环CABG中，STS的ROC曲线下面积为0.82（95%CI 0.73至0.91），EuroSCORE为0.81（95%CI 0.71至0.90）（P=0.616）。STS预测的中风、通气时间延长和肾衰竭风险与观察数据相似，对非体外循环和体外循环CABG均具有相对较好的鉴别力。
结论
STS和EuroSCORE风险算法都是非体外循环或体外循环CABG手术早期死亡率的良好预测指标。然而，在加拿大背景下这些结果的普遍性需要对加拿大各中心进行更广泛的抽样，包括提供体外循环和非体外循环CABG的中心。
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