Department of Coronary Artery Disease, Instituto Dante Pazzanese de Cardiologia, São Paulo, São Paulo, Brazil.
Braz J Cardiovasc Surg. 2024 Sep 6;39(5):e20230282. doi: 10.21470/1678-9741-2023-0282.
Risk prediction models, such as The Society of Thoracic Surgeons (STS) risk score and the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II), are recommended for assessing operative mortality in coronary artery bypass grafting (CABG). However, their performance is questionable in Brazil.
To assess the performance of the STS score and EuroSCORE II in isolated CABG at a Brazilian reference center.
Observationaland prospective study including 438 patients undergoing isolated CABG from May 2022-May 2023 at the Instituto Dante Pazzanese de Cardiologia. Observed mortality was compared with predicted mortality (STS score and EuroSCORE II) by discrimination (area under the curve [AUC]) and calibration (observed/expected ratio [O/E]) in the total sample and subgroups of stable coronary artery disease (CAD) and acute coronary syndrome (ACS).
Observed mortality was 4.3% (n=19) and estimated at 1.21% and 2.74% by STS and EuroSCORE II, respectively. STS (AUC=0.646; 95% confidence interva [CI] 0.760-0.532) and EuroSCORE II (AUC=0.697; 95% CI 0.802-0.593) presented poor discrimination. Calibration was absent for the North American mode (P<0.05) and reasonable for the European model (O/E=1.59, P=0.056). In the subgroups, EuroSCORE II had AUC of 0.616 (95% CI 0.752-0.480) and 0.826 (95% CI 0.991-0.661), while STS had AUC of 0.467 (95% CI 0.622-0.312) and 0.855 (95% CI 1.0-0.706) in ACS and CAD patients, respectively, demonstrating good score performance in stable patients.
The predictive models did not perform optimally in the total sample, but the EuroSCORE was superior, especially in elective stable patients, where accuracy was satisfactory.
风险预测模型，如胸外科医生学会（STS）风险评分和欧洲心脏手术风险评估系统 II （EuroSCORE II），被推荐用于评估冠状动脉旁路移植术（CABG）中的手术死亡率。然而，它们在巴西的表现值得怀疑。
评估 STS 评分和 EuroSCORE II 在巴西参考中心进行的单纯 CABG 中的表现。
这是一项观察性和前瞻性研究，纳入了 2022 年 5 月至 2023 年 5 月期间在 Dante Pazzanese 心脏病学研究所接受单纯 CABG 的 438 例患者。通过鉴别（曲线下面积 [AUC]）和校准（观察到的/预期的比率 [O/E]）比较总样本和稳定型冠状动脉疾病（CAD）和急性冠状动脉综合征（ACS）亚组中的观察到的死亡率和预测的死亡率（STS 评分和 EuroSCORE II）。
观察到的死亡率为 4.3%（n=19），STS 和 EuroSCORE II 分别估计为 1.21%和 2.74%。STS（AUC=0.646；95%置信区间[CI] 0.760-0.532）和 EuroSCORE II（AUC=0.697；95% CI 0.802-0.593）的鉴别能力较差。北美模式的校准不存在（P<0.05），而欧洲模式的校准合理（O/E=1.59，P=0.056）。在亚组中，EuroSCORE II 的 AUC 为 0.616（95% CI 0.752-0.480）和 0.826（95% CI 0.991-0.661），STS 的 AUC 为 0.467（95% CI 0.622-0.312）和 0.855（95% CI 1.0-0.706）在 ACS 和 CAD 患者中，表明稳定患者的评分表现良好。
在总样本中，预测模型表现不佳，但 EuroSCORE 表现更好，特别是在择期稳定患者中，准确性令人满意。
