European Heart Journal Advance Access originally published online on January 18, 2006
European Heart Journal 2006 27(7):867-874; doi:10.1093/eurheartj/ehi720
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Comparison of 19 pre-operative risk stratification models in open-heart surgery
1Department of Cardiothoracic Surgery, Heart and Lung Centre, Lund University Hospital, SE 221 85 Lund, Sweden
2Department of Cardiothoracic Anesthesiology, Heart and Lung Centre, Lund University Hospital, Lund, Sweden
3Competence Centre for Clinical Research, Lund University Hospital, Lund, Sweden
Received 23 August 2005; revised 2 November 2005; accepted 16 December 2005; online publish-ahead-of-print 18 January 2006.
* Corresponding author. Fax: +46 46 15 86 35. E-mail address: johan.nilsson{at}thorax.lu.se
See page 768 for the editorial comment on this article (doi:10.1093/eurheartj/ehi792)
Aims To compare 19 risk score algorithms with regard to their validity to predict 30-day and 1-year mortality after cardiac surgery.
Methods and results Risk factors for patients undergoing heart surgery between 1996 and 2001 at a single centre were prospectively collected. Receiver operating characteristics (ROC) curves were used to describe the performance and accuracy. Survival at 1 year and cause of death were obtained in all cases. The study included 6222 cardiac surgical procedures. Actual mortality was 2.9% at 30 days and 6.1% at 1 year. Discriminatory power for 30-day and 1-year mortality in cardiac surgery was highest for logistic (0.84 and 0.77) and additive (0.84 and 0.77) European System for Cardiac Operative Risk Evaluation (EuroSCORE) algorithms, followed by Cleveland Clinic (0.82 and 0.76) and Magovern (0.82 and 0.76) scoring systems. None of the other 15 risk algorithms had a significantly better discriminatory power than these four. In coronary artery bypass grafting (CABG)-only surgery, EuroSCORE followed by New York State (NYS) and Cleveland Clinic risk score showed the highest discriminatory power for 30-day and 1-year mortality.
Conclusion EuroSCORE, Cleveland Clinic, and Magovern risk algorithms showed superior performance and accuracy in open-heart surgery, and EuroSCORE, NYS, and Cleveland Clinic in CABG-only surgery. Although the models were originally designed to predict early mortality, the 1-year mortality prediction was also reasonably accurate.
Key Words: Mortality • Risk factors • Statistics • Surgery • Survival
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