Ramchandani Bunty K, Polo Luz, Sánchez Raúl, Rey Juvenal, González Álvaro, Díez Jesús, Aroca Ángel
Section of Cardiac Surgery, Hospital Universitario Clínico San Carlos, Madrid, Spain.
Hospital Universitario La Paz, Madrid, Spain.
Korean Circ J. 2019 Sep;49(9):856-863. doi: 10.4070/kcj.2019.0015. Epub 2019 May 7.
Adults with congenital heart disease (CHD) are an increasing group of patients thanks to the survival of over 85% of children with CHD. 20% of these patients shall warrant a surgical procedure during their life span. However, currently there is no one risk score that assess correctly the mortality of these procedures. Thus, we analyse the risk scores used at our institution.
From May 1991 till June 2017, 608 procedures in adults with CHD were performed. The 3 risk scores (risk adjustment for congenital heart surgery [RACHS-1], Aristotle, and Euroscore I) of each procedure were analysed. We used area under the receiver operating characteristic curve (c-index) to measure model discrimination, and Hosmer-Lemeshow (H-L) statistic along with calibration plots to measure calibration.
There was no statistical difference between the area under the curve for the 3 scores (χ²=0.58 with 2 df, p=0.750). There was no evidence of lack of fit for RACHS-1 (H-L, χ²=2.61; p=0.271) and Aristotle score (H-L, χ²=5.69; p=0.459). However, there was evidence in lack of calibration in the Euroscore I scoring system (H-L, χ²=33.69; p<0.001). The calibration slope for RACHS-1 was 0.912, for Aristotle (stratified in risk groups) was -0.14 and for Euroscore 1 (stratified in risk groups) was 0.46.
RACHS-1 seems to be best risk scoring system for calculating mortality applied to surgery in adults with CHD.
由于超过85%的先天性心脏病（CHD）患儿得以存活，患有先天性心脏病的成年患者群体日益壮大。其中20%的患者在其生命周期内需接受外科手术。然而，目前尚无一种风险评分能够准确评估这些手术的死亡率。因此，我们分析了本机构所使用的风险评分。
1991年5月至2017年6月，对608例成年先天性心脏病患者进行了手术。分析了每个手术的3种风险评分（先天性心脏手术风险调整评分[RACHS - 1]、亚里士多德评分和欧洲心脏手术风险评估系统I[Euroscore I]）。我们使用受试者操作特征曲线下面积（c指数）来衡量模型的辨别力，并使用Hosmer - Lemeshow（H - L）统计量以及校准图来衡量校准情况。
3种评分的曲线下面积之间无统计学差异（χ² = 0.58，自由度为2，p = 0.750）。没有证据表明RACHS - 1评分（H - L，χ² = 2.61；p = 0.271）和亚里士多德评分（H - L，χ² = 5.69；p = 0.459）缺乏拟合优度。然而，有证据表明Euroscore I评分系统存在校准不足（H - L，χ² = 33.69；p < 0.001）。RACHS - 1的校准斜率为0.912，亚里士多德评分（按风险组分层）为 - 0.14，Euroscore 1（按风险组分层）为0.46。
RACHS - 1似乎是计算成年先天性心脏病患者手术死亡率的最佳风险评分系统。
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