Kobayashi Kimiyoshi J, Williams Jason A, Nwakanma Lois U, Weiss Eric S, Gott Vincent L, Baumgartner William A, Conte John V
Division of Cardiac Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
J Card Surg. 2009 Nov-Dec;24(6):637-43. doi: 10.1111/j.1540-8191.2009.00906.x.
European system for cardiac operative risk evaluation (EuroSCORE) has been studied for its effectiveness in predicting operative mortality, and more recently, long-term mortality in a wide variety of cardiac surgical procedures. Combined coronary artery bypass and aortic valve replacement (AVR-CABG) carries increased perioperative risk, and tends to have higher-risk patients. Performance of the EuroSCORE system in patients undergoing concomitant AVR-CABG has not been well established. Thus, we aimed to analyze the accuracy of both additive and logistic EuroSCOREs in predicting operative and mid-term mortality.
We retrospectively reviewed and calculated EuroSCOREs for all patients who underwent AVR-CABG between January 2000 and December 2004. Patients who had previous cardiac surgery and those undergoing any concomitant procedures were excluded. Areas under the receiver operator curves (ROC) were determined to assess EuroSCORE's accuracy in predicting operative mortality. Kaplan-Meier analysis and Cox regression were used to determine mid-term survival, freedom from repeat revascularization, and predictors of these outcomes.
There were 233 patients who met study criteria. Mean follow-up period was 2.2 +/- 1.7 years with one patient lost to follow-up. Mean additive and logistic EuroSCOREs were 8.77 and 16.1, respectively, with an observed mortality of 9.44%. The area under the ROC curves for additive EuroSCORE was 0.76 and for logistic EuroSCORE was 0.75. Regression analysis revealed additive EuroSCORE, but not logistic EuroSCORE, to be predictive of mid-term mortality.
Both additive and logistic EuroSCOREs were accurate in predicting operative morality. Only additive EuroSCORE was predictive of mid-term mortality in AVR-CABG patients. EuroSCORE remains a good and well-validated risk stratification model applicable to patients who undergo concomitant AVR-CABG.
欧洲心脏手术风险评估系统（EuroSCORE）已被研究其在预测手术死亡率方面的有效性，最近，在各种心脏外科手术中预测长期死亡率方面也进行了研究。冠状动脉搭桥术联合主动脉瓣置换术（AVR-CABG）的围手术期风险增加，且患者风险往往更高。EuroSCORE系统在接受同期AVR-CABG手术的患者中的表现尚未得到充分证实。因此，我们旨在分析相加式和逻辑EuroSCOREs在预测手术和中期死亡率方面的准确性。
我们回顾性分析并计算了2000年1月至2004年12月期间接受AVR-CABG手术的所有患者的EuroSCOREs。排除既往有心脏手术史的患者和接受任何同期手术的患者。通过确定受试者工作特征曲线（ROC）下的面积来评估EuroSCORE在预测手术死亡率方面的准确性。采用Kaplan-Meier分析和Cox回归来确定中期生存率、免于再次血运重建情况以及这些结果的预测因素。
有233例患者符合研究标准。平均随访期为2.2±1.7年，1例患者失访。相加式和逻辑EuroSCOREs的平均值分别为8.77和16.1，观察到的死亡率为9.44%。相加式EuroSCORE的ROC曲线下面积为0.76，逻辑EuroSCORE的ROC曲线下面积为0.75。回归分析显示，相加式EuroSCORE而非逻辑EuroSCORE可预测中期死亡率。
相加式和逻辑EuroSCOREs在预测手术死亡率方面均准确。只有相加式EuroSCORE可预测AVR-CABG患者的中期死亡率。EuroSCORE仍然是一个适用于接受同期AVR-CABG手术患者且经过充分验证的良好风险分层模型。
