Barili Fabio, Pacini Davide, D'Ovidio Mariangela, Dang Nicholas C, Alamanni Francesco, Di Bartolomeo Roberto, Grossi Claudio, Davoli Marina, Fusco Danilo, Parolari Alessandro
Department of Cardiac Surgery, S. Croce Hospital, Cuneo.
Department of Cardiac Surgery, University of Bologna, Bologna.
Ann Thorac Surg. 2016 Oct;102(4):1296-303. doi: 10.1016/j.athoracsur.2016.04.017. Epub 2016 Jun 17.
The European System for Cardiac Operation Risk Evaluation (EuroSCORE) II has not been tested yet for predicting long-term mortality. This study was undertaken to evaluate the relationship between EuroSCORE II and long-term mortality and to develop a new algorithm based on EuroSCORE II factors to predict long-term survival after cardiac surgery.
Complete data on 10,033 patients who underwent major cardiac surgery during a 7-year period were retrieved from three prospective institutional databases and linked with the Italian Tax Register Information System. Mortality at follow-up was analyzed with time-to-event analysis.
The Kaplan-Meier estimates of survival at 1 and 5 were, respectively, 95.0% ± 0.2% and 84.7% ± 0.4%. Both discrimination and calibration of EuroSCORE II decreased in the prediction of 1-year and 5-year mortality. Nonetheless, EuroSCORE II was confirmed to be an independent predictor of long-term mortality with a nonlinear trend. Several EuroSCORE II variables were independent risk factors for long-term mortality in a regression model, most of all very low ejection fraction (less than 20%), salvage operation, and dialysis. In the final model, isolated mitral valve surgery and isolated coronary artery bypass graft surgery were associated with improved long-term survival.
The EuroSCORE II cannot be considered a direct estimator of long-term risk of death, as its performance fades for mortality at follow-up longer than 30 days. Nonetheless, it is nonlinearly associated with long-term mortality, and most of its variables are risk factors for long-term mortality. Hence, they can be used in a different algorithm to stratify the risk of long-term mortality after surgery.
欧洲心脏手术风险评估系统（EuroSCORE）II尚未用于预测长期死亡率。本研究旨在评估EuroSCORE II与长期死亡率之间的关系，并基于EuroSCORE II因素开发一种新算法，以预测心脏手术后的长期生存率。
从三个前瞻性机构数据库中检索了7年期间接受心脏大手术的10033例患者的完整数据，并与意大利税务登记信息系统进行关联。采用事件发生时间分析对随访期间的死亡率进行分析。
1年和5年生存率的Kaplan-Meier估计值分别为95.0%±0.2%和84.7%±0.4%。在预测1年和5年死亡率时，EuroSCORE II的区分度和校准度均有所下降。尽管如此，EuroSCORE II被证实是长期死亡率的独立预测因子，呈非线性趋势。在回归模型中，几个EuroSCORE II变量是长期死亡率的独立危险因素，但极低射血分数（低于20%）、挽救性手术和透析最为显著。在最终模型中，单纯二尖瓣手术和单纯冠状动脉搭桥手术与长期生存率提高相关。
EuroSCORE II不能被视为长期死亡风险的直接估计指标，因为其在随访时间超过30天的死亡率预测中表现不佳。尽管如此，它与长期死亡率呈非线性相关，并且其大多数变量是长期死亡率的危险因素。因此，它们可用于不同的算法中，以对术后长期死亡风险进行分层。
