Department of Cardiac Surgery, S Croce Hospital, Cuneo, Italy.
Department of Cardiac Surgery, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy.
J Thorac Cardiovasc Surg. 2014 Mar;147(3):1008-12. doi: 10.1016/j.jtcvs.2013.06.042. Epub 2013 Aug 28.
The study was designed to validate euroSCORE II and ACEF (age, creatinine, and ejection fraction) scores in patients undergoing isolated or associated mitral valve surgery and compare them with logistic euroSCORE and Society of Thoracic Surgeons scores.
Data on 3441 consecutive patients undergoing isolated or associated mitral valve surgery in a 6-year period were retrieved from 3 prospective institutional databases. Discriminatory power was assessed with the C index. Calibration was evaluated with calibration curves and associated statistics.
In-hospital mortality was 3.4%. Discriminatory power was uniformly good (for euroSCORE II: area under curve, 0.79; 95% confidence interval, 0.74-0.84; for logistic euroSCORE: area under the curve, 0.78; 95% confidence interval, 0.74-0.83; for ACEF: area under the curve, 0.73; 95% confidence interval, 0.69-0.79) but significantly higher in euroSCORE models (P < .05 for Delong, bootstrap, Venkatraman methods). Calibration pattern was slightly better for the ACEF score, although related summary statistics (unreliability, Hosmer-Lemeshow test, Spiegelhalter z-test for calibration accuracy) were not significant even for euroSCORE II. The euroSCORE II demonstrated a performance similar to Society of Thoracic Surgeons score. Logistic euroSCORE confirmed the progressive trend toward overprediction previously demonstrated in the general cardiac surgical population (summary statistics P < .05). Analysis of score performances in the surgical group studied showed results comparable to the global population.
The euroSCORE II and ACEF scores are good predictors of perioperative mortality in patients undergoing isolated or associated mitral valve surgery, with better discrimination for the first and better calibration for the second. No algorithm seems suitable for risk estimation in mid and high-risk patients.
本研究旨在验证在接受单纯或联合二尖瓣手术的患者中使用欧洲心脏手术风险评分 II （euroSCORE II）和 ACEF（年龄、肌酐和射血分数）评分，并将其与逻辑欧洲心脏手术风险评分和胸外科医师学会评分进行比较。
从 3 个前瞻性机构数据库中检索了 3441 例连续接受单纯或联合二尖瓣手术的患者数据。使用 C 指数评估判别能力。通过校准曲线和相关统计数据评估校准。
院内死亡率为 3.4%。判别能力均较高（对于 euroSCORE II：曲线下面积为 0.79；95%置信区间，0.74-0.84；对于逻辑欧洲心脏手术风险评分：曲线下面积为 0.78；95%置信区间，0.74-0.83；对于 ACEF：曲线下面积为 0.73；95%置信区间，0.69-0.79），但在 euroSCORE 模型中显著更高（P<0.05，采用 Delong、bootstrap、Venkatraman 方法）。ACEF 评分的校准模式略好，但相关汇总统计数据（不可靠性、Hosmer-Lemeshow 检验、校准准确性 Spiegelhalter z 检验）即使对于 euroSCORE II 也不显著。euroSCORE II 显示出与胸外科医师学会评分相似的性能。逻辑欧洲心脏手术风险评分证实了在一般心脏手术人群中先前显示的过度预测趋势（汇总统计数据 P<0.05）。在研究的手术组中分析评分性能，结果与全球人群相当。
在接受单纯或联合二尖瓣手术的患者中，euroSCORE II 和 ACEF 评分是围手术期死亡率的良好预测指标，前者的判别能力更好，后者的校准能力更好。没有一种算法似乎适合中高危患者的风险估计。
