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External validation of the REMEMBER score

Armin Darius Peivandi1, Henryk Welp1, Sebastian Kintrup2

  • 1Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany.

Frontiers in Cardiovascular Medicine
|August 14, 2023
PubMed

Insights

The REMEMBER score, designed to predict mortality after coronary artery bypass grafting (CABG) with venoarterial extracorporeal membrane oxygenation (VA-ECMO), showed poor performance in external validation. This score is not applicable for predicting in-hospital mortality in this patient group.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Critical Care Medicine

Background:

  • Venoarterial extracorporeal membrane oxygenation (VA-ECMO) use after coronary artery bypass grafting (CABG) is linked to high in-hospital mortality.
  • The REMEMBER score was developed to predict in-hospital mortality in CABG patients requiring VA-ECMO.

Purpose of the Study:

  • To externally validate the predictive performance of the REMEMBER score in a distinct cohort of CABG patients who underwent VA-ECMO.
  • To assess the REMEMBER score's accuracy in predicting in-hospital mortality.

Main Methods:

  • Retrospective analysis of 107 CABG patients who received VA-ECMO between 2012 and 2021.
  • Evaluation of the REMEMBER score's discriminative ability using concordance statistics and ROC curve analysis.
  • Assessment of calibration using calibration-in-the-large and calibration slope.

Main Results:

  • The study included 107 patients, with an in-hospital mortality rate of 45.8%.
  • The REMEMBER score demonstrated low discriminative ability (AUC: 0.623) and poor calibration (intercept p=0.0195, slope p=0.0303).
  • The median predicted mortality rate by the REMEMBER score was 52%, differing from the observed rate.

Conclusions:

  • The REMEMBER score was found to be inaccurate and not applicable for predicting in-hospital mortality in this cohort of CABG patients treated with VA-ECMO.
  • Further external validation studies, preferably in a multicenter setting, are recommended to confirm these findings.
Abstract

Keywords:
cardiac failurecoronary artery bypass graftingextracorporeal life supportrisk scorescore system

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