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Published on: March 27, 2018
The Asian system for cardiac operative risk evaluation for predicting mortality after isolated coronary artery bypass
Hai Dong Luo1,2, Leok-Kheng Kristine Teoh1,2, Mario Fl Gaudino3
1Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, National University Health System, Singapore, Singapore.
Insights
A new risk scoring system, ASCORE-C, was developed for Asian patients undergoing coronary artery bypass graft surgery (CABG). This system accurately predicts early mortality, outperforming Western models for this population.
Area of Science:
- Cardiovascular Surgery
- Public Health
- Medical Informatics
Background:
- Western risk models inadequately predict coronary artery bypass graft surgery (CABG) mortality in Asian populations.
- Developing a tailored risk assessment tool for Asian patients is crucial for improving surgical outcomes.
- Early mortality prediction is essential for patient management and resource allocation in cardiac surgery.
Purpose of the Study:
- To develop and validate a novel risk scoring system, the Asian System for Cardiac Operative Risk Evaluation in CABG (ASCORE-C), for predicting early mortality in a multiracial Asian patient cohort undergoing isolated CABG.
- To compare the predictive performance of ASCORE-C against established Western risk models like EuroSCORE II and STS score.
Main Methods:
- A cohort of 2495 patients undergoing isolated CABG in Singapore (2009-2015) was used to develop the ASCORE-C system.
- Stepwise logistic regression identified predictors of 30-day, 90-day, and 1-year mortality.
- ASCORE-C performance was evaluated against EuroSCORE II and STS score using validation datasets and observed/estimated mortality ratios.
Main Results:
- Observed cumulative mortality rates were 2.6% (30-day), 3.3% (90-day), and 4.6% (1-year).
- Key predictors for ASCORE-C included age, Malay ethnicity, congestive heart failure, abnormal heart rhythm, aortic atherosclerosis, renal function, peripheral vascular disease, critical status, and emergency surgery.
- ASCORE-C demonstrated superior predictive accuracy compared to EuroSCORE II and STS score, particularly for high-risk patients.
Conclusions:
- The ASCORE-C system provides a reliable and accurate method for predicting early-stage mortality in multiracial Asian patients undergoing CABG.
- ASCORE-C offers improved risk stratification for Asian populations, enabling more personalized surgical decision-making and postoperative care.
- This regional scoring system addresses the limitations of existing Western models in predicting CABG outcomes in diverse Asian demographics.
Objective:
The mortality of coronary artery bypass graft surgery (CABG) in Asian patients predicted by Western population-based risk models is not ideal. We aimed to develop a risk scoring system based on a multiracial Asian patient population to predict early-stage mortality.
Methods:
A total of 2495 patients who underwent isolated CABG in Singapore from 2009 to 2015 were included to develop a regional scoring system: the regional Asian System for Cardiac Operative Risk Evaluation in CABG (ASCORE-C). Predictors were identified via a stepwise multiple logistic regression to construct models for 30-day, 90-day, and 1-year cumulative mortality prediction. The optimal cut-offs of ASCORE-C risk strata were determined by the multiway χ2 and Interaction Detection decision tree. The performance of ASCORE-C was compared with European System for Cardiac Operative Risk Evaluation score (EuroSCORE) II and Society of Thoracic Surgeons (STS) score by observed/estimated mortality ratio.
Results:
The observed postoperative 30-day, 90-day, and 1-year cumulative mortality following isolated CABG were 2.6%, 3.3%, and 4.6%, respectively. The ASCORE-C to predict these three events were constructed with age (>65 years), Malay ethnicity, congestive heart failure, abnormal heart rhythm, aortic atherosclerosis, estimated glomerular filtration rate, peripheral vascular disease, critical preoperative status, and emergency surgery. Tested by three different validation datasets, receiver operating characteristic curve of ASCORE-C model prediction performed well with the Hosmer-Lemeshow test. The ASCORE-C was found to have better predictive accuracy than EuroSCORE II and STS score in CABG mortality prediction, especially for the high-risk patients.
Conclusion:
The ASCORE-C system is reliable for early-stage CABG mortality prediction in a multiracial Asian population.
