Qadir Irfan, Salick Muhammad Musa, Perveen Shazia, Sharif Hasanat
Department of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi, Pakistan.
Interact Cardiovasc Thorac Surg. 2012 Mar;14(3):258-62. doi: 10.1093/icvts/ivr072. Epub 2011 Dec 18.
We compared the performances of the additive European System for Cardiac Operative Risk Evaluation, EuroSCORE (AES) and logistic EuroSCORE (LES) with the Society of Thoracic Surgeons' risk prediction algorithm in terms of discrimination and calibration in predicting mortality in patients undergoing isolated coronary artery bypass grafting (CABG) at a single institution in Pakistan. Both models were applied to 380 patients, operated upon at the Aga Khan University Hospital from August 2009 to July 2010. The actual mortality was 2.89%. The mean AES of all patients was 4.36 ± 3.58%, the mean LES was 5.96 ± 9.18% and the mean Society of Thoracic Surgeons' (STS) score was 2.30 ± 4.16%. The Hosmer-Lemeshow goodness-of-fit test gave a P-value of 0.801 for AES, 0.699 for LES and 0.981 for STS. The area under the receiver operating characteristic curve was 0.866 for AES, 0.842 for LES and 0.899 for STS. STS outperformed AES and LES both in terms of calibration and discrimination. STS, however, underestimated mortality in the top 20% of patients having an STS score >2.88, thus overall STS estimates were lower than actual mortality. We conclude that STS is a more accurate model for risk assessment as compared to additive and logistic EuroSCORE models in the Pakistani population.
我们在巴基斯坦一家机构，就单纯冠状动脉旁路移植术（CABG）患者死亡率预测的区分度和校准度，比较了欧洲心脏手术风险评估系统（EuroSCORE）的相加模型（AES）和逻辑EuroSCORE（LES）与胸外科医师协会风险预测算法的性能。这两种模型都应用于2009年8月至2010年7月在阿迦汗大学医院接受手术的380例患者。实际死亡率为2.89%。所有患者的平均AES为4.36±3.58%，平均LES为5.96±9.18%，胸外科医师协会（STS）评分的平均值为2.30±4.16%。Hosmer-Lemeshow拟合优度检验得出AES的P值为0.801，LES为0.699，STS为0.981。AES的受试者工作特征曲线下面积为0.866，LES为0.842，STS为0.899。在校准和区分度方面，STS均优于AES和LES。然而，STS对STS评分>2.88的前20%患者的死亡率估计偏低，因此总体STS估计低于实际死亡率。我们得出结论，在巴基斯坦人群中，与相加和逻辑EuroSCORE模型相比，STS是一种更准确的风险评估模型。
