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Published on: December 11, 2017
Comparing Performance of Risk Scores for Combined Aortic Valve Replacement and Coronary Bypass Grafting Surgery
Tom Kai Ming Wang1, David H M Choi1, Tharumenthiran Ramanathan1
1Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
Insights
The Society of Thoracic Surgeons (STS) score offers the best prediction of mortality and complications for patients undergoing combined aortic valve replacement and coronary artery bypass grafting (AVR+CABG). This score aids in risk stratification for these complex cardiac surgeries.
Area of Science:
- Cardiac Surgery
- Cardiovascular Medicine
- Medical Statistics
Background:
- Aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) are common cardiac procedures, with increasing demand due to an aging population.
- Accurate risk stratification is crucial for predicting outcomes and guiding intervention choices in cardiac surgery, yet it's understudied for combined AVR+CABG.
- This study compares the prognostic utility of three major risk scores: EuroSCORE, EuroSCORE II, and the Society of Thoracic Surgeons' (STS) Score for AVR+CABG.
Purpose of the Study:
- To evaluate and compare the accuracy of EuroSCORE, EuroSCORE II, and STS Score in predicting mortality and morbidity after combined AVR+CABG.
- To determine the most effective risk stratification tool for patients undergoing this complex dual cardiac procedure.
Main Methods:
- A cohort of 450 patients undergoing combined AVR+CABG at Auckland City Hospital between 2005-2012 was analyzed.
- The EuroSCORE, EuroSCORE II, and STS Score were calculated for each patient.
- The discrimination and calibration of each score for predicting operative mortality and various morbidities were assessed over a mean follow-up of 4.7 years.
Main Results:
- Operative mortality was 6.4%. Mean scores were: EuroSCORE 12.5%, EuroSCORE II 6.6%, and STS Score 5.5%.
- The STS Score demonstrated the best discrimination for operative mortality (C-statistic=0.699) and was superior for predicting follow-up mortality, composite morbidity, stroke, prolonged ventilation, and return to theatre.
- Independent predictors of operative mortality included a history of myocardial infarction and impaired renal function.
Conclusions:
- The STS Score exhibits superior discriminative ability for mortality and most complications following combined AVR+CABG compared to EuroSCORE and EuroSCORE II.
- The STS Score's calibration was comparable to EuroSCORE II and better than the original EuroSCORE.
- The STS Score is recommended for risk stratification and decision-making regarding surgical versus percutaneous interventions in patients with concurrent aortic valve and coronary artery disease.
Background:
Aortic valve replacement (AVR) and/or coronary artery bypass grafting (CABG) make up the majority of cardiac surgery with increasing demand as the population ages. Accuracy of risk stratification is important, in predicting adverse outcomes and selecting modality of intervention, but has been rarely studied for the combined AVR+CABG operation. We compared the prognostic utility of EuroSCORE, EuroSCORE II and Society of Thoracic Surgeons' (STS) Score for AVR+CABG.
Methods:
All patients (n=450) undergoing AVR+CABG at Auckland City Hospital during 2005-2012 with mean follow-up of 4.7+/-2.5 years were included. The three risk scores were calculated and their discrimination and calibration for mortality and morbidities assessed.
Results:
Operative mortality was 6.4% (29), and mean scores were EuroSCORE 12.5+/-11.1%, EuroSCORE II 6.6+/-6.1% and STS Score 5.5+/-4.4%. C-statistics were 0.587, 0.669 and 0.699 respectively for operative mortality, Hosmer-Lemeshow test P-values were 0.064, 0.718 and 0.567, and Brier Score 0.716, 0.585 and 0.588. Independent predictors of operative mortality were history of myocardial infarction and impaired renal function. Society of Thoracic Surgeons' score also was the most accurate score for predicting mortality during follow-up (c=0.663), composite morbidity (c=0.627), stroke (c=0.642), prolonged ventilation>24hours (c=0.642), and return to theatre (c=0.612).
Conclusion:
The STS score has the best discriminative ability for mortality and the majority of complications after AVR+CABG, while its calibration was similar to EuroSCORE II and superior to EuroSCORE. It should therefore be used for risk stratification and when considering surgical versus percutaneous intervention in those with concurrent aortic valve and coronary artery disease.
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