Luo Hai Dong, Teoh Leok-Kheng Kristine, Gaudino Mario Fl, Fremes Stephen, Kofidis Theo
Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, National University Health System, Singapore, Singapore.
Department of Cardiac, Thoracic and Vascular Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
J Card Surg. 2020 Oct;35(10):2574-2582. doi: 10.1111/jocs.14836. Epub 2020 Jul 11.
The mortality of coronary artery bypass graft surgery (CABG) in Asian patients predicted by Western population-based risk models is not ideal. We aimed to develop a risk scoring system based on a multiracial Asian patient population to predict early-stage mortality.
A total of 2495 patients who underwent isolated CABG in Singapore from 2009 to 2015 were included to develop a regional scoring system: the regional Asian System for Cardiac Operative Risk Evaluation in CABG (ASCORE-C). Predictors were identified via a stepwise multiple logistic regression to construct models for 30-day, 90-day, and 1-year cumulative mortality prediction. The optimal cut-offs of ASCORE-C risk strata were determined by the multiway χ and Interaction Detection decision tree. The performance of ASCORE-C was compared with European System for Cardiac Operative Risk Evaluation score (EuroSCORE) II and Society of Thoracic Surgeons (STS) score by observed/estimated mortality ratio.
The observed postoperative 30-day, 90-day, and 1-year cumulative mortality following isolated CABG were 2.6%, 3.3%, and 4.6%, respectively. The ASCORE-C to predict these three events were constructed with age (>65 years), Malay ethnicity, congestive heart failure, abnormal heart rhythm, aortic atherosclerosis, estimated glomerular filtration rate, peripheral vascular disease, critical preoperative status, and emergency surgery. Tested by three different validation datasets, receiver operating characteristic curve of ASCORE-C model prediction performed well with the Hosmer-Lemeshow test. The ASCORE-C was found to have better predictive accuracy than EuroSCORE II and STS score in CABG mortality prediction, especially for the high-risk patients.
The ASCORE-C system is reliable for early-stage CABG mortality prediction in a multiracial Asian population.
西方基于人群的风险模型预测亚洲患者冠状动脉旁路移植术（CABG）的死亡率并不理想。我们旨在基于多民族亚洲患者群体开发一种风险评分系统，以预测早期死亡率。
纳入2009年至2015年在新加坡接受单纯CABG的2495例患者，以开发一种区域评分系统：CABG中亚洲心脏手术风险评估区域系统（ASCORE-C）。通过逐步多元逻辑回归确定预测因素，以构建30天、90天和1年累积死亡率预测模型。ASCORE-C风险分层的最佳临界值由多向χ检验和交互检测决策树确定。通过观察/估计死亡率比，将ASCORE-C的性能与欧洲心脏手术风险评估系统评分（EuroSCORE）II和胸外科医师协会（STS）评分进行比较。
单纯CABG术后观察到的30天、90天和1年累积死亡率分别为2.6%、3.3%和4.6%。ASCORE-C用于预测这三个事件的构建因素包括年龄（>65岁）、马来族裔、充血性心力衰竭、心律失常、主动脉粥样硬化、估计肾小球滤过率、外周血管疾病、术前危急状态和急诊手术。通过三个不同的验证数据集进行测试，ASCORE-C模型预测的受试者工作特征曲线在Hosmer-Lemeshow检验中表现良好。发现在CABG死亡率预测中，ASCORE-C比EuroSCORE II和STS评分具有更好的预测准确性，尤其是对于高危患者。
ASCORE-C系统在多民族亚洲人群中对CABG早期死亡率预测是可靠的。
