Related Experiment Video
Updated: Oct 26, 2025
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Mortality risk prediction in high-risk patients undergoing coronary artery bypass grafting: Are traditional risk
Maxim Goncharov1, Omar Asdrúbal Vilca Mejia1,2, Camila Perez de Souza Arthur3
1Department of Cardiovascular Surgery, Instituto do Coração, University of São Paulo, São Paulo, Brazil.
Insights
The HiriSCORE model accurately predicts mortality in high-risk cardiac surgery patients undergoing CABG, outperforming traditional STS and ESII scores. This new model offers improved accuracy for predicting patient outcomes in complex cardiovascular procedures.
Area of Science:
- Cardiovascular Surgery
- Medical Informatics
- Clinical Prediction Models
Background:
- Traditional mortality prediction scores (STS, ESII) show limitations in high-risk cardiac surgery.
- Coronary Artery Bypass Grafting (CABG) involves significant patient risk.
- Accurate mortality prediction is crucial for optimizing patient care and surgical planning.
Purpose of the Study:
- To compare the predictive performance of the HiriSCORE model against traditional STS and ESII scores.
- To evaluate the accuracy of these models in predicting mortality among high-risk patients undergoing CABG.
- To identify a more effective tool for risk stratification in complex cardiac surgery.
Main Methods:
- Cross-sectional analysis of an international prospective database (HiriSCORE project).
- Inclusion of 248 high-risk patients undergoing CABG with STS or ESII scores between 5-10%.
- Evaluation of model performance using calibration-in-the-large and Receiver Operating Curve (ROC) analyses.
Main Results:
- The HiriSCORE model demonstrated superior calibration (15.0%) compared to ESII (6.6%) and STS (2.0%).
- HiriSCORE achieved higher accuracy on ROC analysis (0.74) than STS (0.67) and ESII (0.50).
- Observed mortality in the study cohort was 13.31%.
Conclusions:
- Traditional models (STS, ESII) are inadequate for predicting mortality in high-risk CABG patients.
- The HiriSCORE model is a simple and accurate tool for predicting mortality in this patient population.
- HiriSCORE offers improved risk stratification for high-risk cardiac surgery patients.
Background:
The performance of traditional scores is significantly limited to predict mortality in high-risk cardiac surgery. The aim of this study was to compare the performance of STS, ESII and HiriSCORE models in predicting mortality in high-risk patients undergoing CABG.
Methods:
Cross-sectional analysis in the international prospective database of high-risk patients: HiriSCORE project. We evaluated 248 patients with STS or ESII (5-10%) undergoing CABG in 8 hospitals in Brazil and China. The main outcome was mortality, defined as all deaths occurred during the hospitalization in which the operation was performed, even after 30 days. Five variables were selected as predictors of mortality in this cohort of patients. The model's performance was evaluated through the calibration-in-the-large and the receiver operating curve (ROC) tests.
Results:
The mean age was 69.90±9.45, with 52.02% being female, 25% of the patients were on New York Heart Association (NYHA) class IV and 49.6% had Canadian Cardiovascular Society (CCS) class 4 angina, and 85.5% had urgency or emergency status. The mortality observed in the sample was 13.31%. The HiriSCORE model showed better calibration (15.0%) compared to ESII (6.6%) and the STS model (2.0%). In the ROC curve, the HiriSCORE model showed better accuracy (ROC = 0.74) than the traditional models STS (ROC = 0.67) and ESII (ROC = 0.50).
Conclusion:
Traditional models were inadequate to predict mortality of high-risk patients undergoing CABG. However, the HiriSCORE model was simple and accurate to predict mortality in high-risk patients.
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:30Coronary Artery Disease I: Introduction
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies