Related Experiment Video
Updated: Feb 19, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Predicting operative mortality in octogenarians for isolated coronary artery bypass grafting surgery: a retrospective
Jessica G Y Luc1, Michelle M Graham2,3, Colleen M Norris1,2,3
1Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
Insights
Cardiac surgery risk scores overestimate risk in octogenarians. EuroSCORE II showed better prediction accuracy for elderly patients undergoing coronary artery bypass grafting (CABG).
Area of Science:
- Cardiology
- Cardiac Surgery
- Health Outcomes Research
Background:
- Existing cardiac surgery risk scores lack validation in octogenarian populations.
- The Society of Thoracic Surgeons (STS) score, EuroSCORE I, and EuroSCORE II are commonly used for risk prediction.
- Accurate risk assessment is crucial for elderly patients undergoing major procedures.
Purpose of the Study:
- To compare the predictive performance of STS score, EuroSCORE I, and EuroSCORE II.
- To evaluate these scores in octogenarians undergoing isolated coronary artery bypass grafting (CABG).
- To identify the most accurate risk prediction model for this specific demographic.
Main Methods:
- Retrospective analysis of isolated CABG patients (2002-2008) from the APPROACH registry.
- Matched cohort study comparing octogenarians (≥80 years) with younger patients (<80 years).
- Calculation of STS, additive EuroSCORE, logistic EuroSCORE I, and EuroSCORE II; assessment of discriminatory accuracy using AUC.
Main Results:
- All risk scores significantly overestimated mortality in octogenarians compared to younger patients.
- Observed mortality was 2% in octogenarians vs. 1% in younger patients (p=0.323).
- EuroSCORE II demonstrated superior discriminatory accuracy (AUC=0.794) in octogenarians compared to STS, EuroSCORE I (AUCs: 0.671, 0.709, 0.694).
Conclusions:
- Current cardiac surgery risk scores overestimate surgical risk, especially in octogenarians.
- EuroSCORE II offers better discriminatory accuracy for predicting outcomes in elderly CABG patients.
- Incorporating factors like frailty may enhance the predictive power of existing risk models for octogenarians.
Background:
Available cardiac surgery risk scores have not been validated in octogenarians. Our objective was to compare the predictive ability of the Society of Thoracic Surgeons (STS) score, EuroSCORE I, and EuroSCORE II in elderly patients undergoing isolated coronary artery bypass grafting surgery (CABG).
Methods:
All patients who underwent isolated CABG (2002 - 2008) were identified from the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) registry. All patients aged 80 and older (n = 304) were then matched 1:2 with a randomly selected control group of patients under age 80 (n = 608 of 4732). Risk scores were calculated. Discriminatory accuracy of the risk models was assessed by plotting the areas under the receiver operator characteristic (AUC) and comparing the observed to predicted operative mortality.
Results:
Octogenarians had a significantly higher predicted mortality by STS Score (3 ± 2% vs. 1 ± 1%; p < 0.001), additive EuroSCORE (8 ± 3% vs. 4 ± 3%; p < 0.001), logistic EuroSCORE (15 ± 14% vs. 5 ± 6%; p < 0.001), and EuroSCORE II (4 ± 3% vs. 2 ± 2%; p < 0.001) compared to patients under age 80 years. Observed mortality was 2% and 1% for patients age 80 and older and under age 80, respectively (p = 0.323). AUC revealed areas for STS, additive and logistic EuroSCORE I and EuroSCORE II, respectively, for patients age 80 and older (0.671, 0.709, 0.694, 0.794) and under age 80 (0.829, 0.750, 0.785, 0.845).
Conclusion:
All risk prediction models assessed overestimated surgical risk, particularly in octogenarians. EuroSCORE II demonstrated better discriminatory accuracy in this population. Inclusion of new variables into these risk models, such as frailty, may allow for more accurate prediction of true operative risk.
More Related Videos
09:12Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
07:25Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
