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An R-Based Landscape Validation of a Competing Risk Model
Published on: September 16, 2022
[Prediction value for operative mortality of four different coronary artery bypass graft risk stratification models
Zhe Zheng1, You Zhou, Hua-wei Gao
1Department of Surgery, Cardiovascular Institute, Fu Wai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China. zhengzhefw@hotmail.com
Insights
The OPR scoring system accurately predicted operative mortality in Chinese patients undergoing coronary artery bypass graft (CABG) surgery. While other models overestimated risk, OPR demonstrated the best prognostic accuracy for this patient group.
Area of Science:
- Cardiovascular Surgery
- Medical Informatics
- Health Services Research
Context:
- Coronary artery bypass graft (CABG) surgery is a major cardiovascular procedure.
- Accurate risk stratification is crucial for patient management and resource allocation.
- Existing risk models may have varying performance in different ethnic populations.
Purpose:
- To evaluate the prognostic accuracy of four risk stratification models (Parsonnet, EuroSCORE, Cleveland, OPR) for operative mortality in Chinese patients undergoing CABG.
- To compare the calibration and discrimination of these models.
- To identify the most suitable model for predicting outcomes in this specific demographic.
Summary:
- A prospective study involving 2251 Chinese patients undergoing CABG compared the Parsonnet, EuroSCORE, Cleveland, and OPR scoring systems.
- The OPR model demonstrated the best calibration and accurately predicted the observed operative mortality (1.87%), while other models overestimated risk.
- All models showed acceptable to excellent discrimination, with EuroSCORE performing best (AUC 0.813).
Impact:
- The OPR scoring system is recommended as the most accurate tool for predicting operative mortality in Chinese patients undergoing CABG.
- Findings highlight the importance of validating risk models in diverse populations.
- Improved risk prediction can lead to better surgical decision-making and patient counseling.
Objective:
To assess the prognostic accuracy for operative mortality of 4 different risk stratification models in Chinese patients underwent (coronary artery bypass graft) CABG.
Methods:
Between 2002 and 2003, all patients undergoing CABG in our institution were prospectively scored for operative mortality using Parsonnet, EuroSCORE, Cleveland and OPR scoring systems and operative mortality was registered. Operative mortality is defined as postoperative death of any cause during hospitalization. Calibration was estimated using the Hosmer-Lemeshow goodness-of-fit test. Discrimination was evaluated using receiver operating characteristic (ROC) curves and area under a ROC curve (AUC).
Results:
Follow-up was able to be completed in 2251 prospectively scored patients. Registered operative mortality was 1.87% (42/2251). The overall expected mortality calculated by Parsonnet, EuroSCORE, Cleveland and OPR scoring systems were 5.78%, 2.82%, 3.30% and 1.65%, respectively. The actual operative mortality was within the range of 95% confidence interval of OPR model and the other 3 predicted significantly higher operative mortality. Among the four risk scores, Calibration was good in OPR model (chi(2) = 4.842, P = 20.182) and poor in other 3 models (P < 0.001) while discrimination was acceptable in Parsonnet, Cleveland and OPR scoring systems (AUC: 0.711, 0.754, 0.757, respectively) and excellent in EuroSCORE scoring system (0.813).
Conclusion:
For Chinese patients undergoing CABG, OPR scoring system best predicted the operative mortality. All systems could be used to discriminate operative mortality for individual patient.