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Society of Thoracic Surgeons Risk Score and EuroSCORE-2 Appropriately Assess 30-Day Postoperative Mortality in the

Nadia Bouabdallaoui1, Susanna R Stevens2, Torsten Doenst3

  • 1Departments of Medicine, ontreal Heart Institute, University of Montreal, Canada (N.B., J.L.R.).

Circulation. Heart Failure
|December 21, 2018
PubMed

Insights

The Society of Thoracic Surgeons (STS) and EuroSCORE-2 (ES2) risk scores effectively assess 30-day mortality after coronary artery bypass grafting in patients with left ventricular dysfunction, though STS scores tend to underestimate risk.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery Risk Assessment
  • Medical Device Evaluation

Background:

  • The STICH trial confirmed survival benefits of coronary artery bypass grafting (CABG) for ischemic cardiomyopathy.
  • Accurate risk assessment is crucial for CABG in patients with left ventricular dysfunction (LVD).
  • Limited data exist on the performance of STS and EuroSCORE-2 (ES2) in LVD patients undergoing CABG.

Purpose of the Study:

  • To evaluate the accuracy of the Society of Thoracic Surgeons (STS) risk score and EuroSCORE-2 (ES2) in predicting 30-day postoperative mortality.
  • To compare the predictive performance of STS and ES2 in patients with left ventricular ejection fraction (LVEF) ≤35% undergoing CABG.
  • To assess risk stratification in both a clinical trial (STICH) and a contemporary cohort (CC) of LVD patients.

Main Methods:

  • Calculated STS and ES2 scores for 814 STICH patients and 1246 contemporary cohort (CC) patients.
  • Analyzed 30-day postoperative mortality rates in both cohorts.
  • Assessed the predictive accuracy using C-statistics for STS and ES2 scores.

Main Results:

  • Significant variation in 30-day postoperative mortality risk was observed.
  • STS scores consistently yielded lower risk estimates than ES2.
  • Both scores demonstrated moderately good predictive accuracy (C-statistics ranging from 0.707 to 0.744).
  • Contemporary cohort patients had higher STS/ES2 scores but lower mortality than STICH patients, suggesting improved outcomes over time.

Conclusions:

  • 30-day postoperative mortality risk in CABG patients with LVD varies considerably.
  • Both STS and ES2 scores are effective tools for risk evaluation in this population.
  • The STS score tends to underestimate the actual postoperative mortality risk.
Abstract

Keywords:
coronary artery bypasscoronary artery diseaseheart failurerisk stratification

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