PDF(Pubmed)
Abstract：
Background: EuroSCORE II (ES2) is a reliable tool for preoperative cardiac surgery mortality risk prediction; however, a patient\'s age, a surgical procedure\'s weight and the new devices available may cause its accuracy to drift. We sought to investigate ES2 performance related to the surgical risk and late mortality estimation in patients who underwent aortic valve replacement (AVR) with sutureless valves. Methods: Between 2012 and 2021, a total of 1126 patients with isolated aortic stenosis who underwent surgical AVR by means of sutureless valves were retrospectively collected from six European centers. Patients were stratified into three groups according to the EuroSCORE II risk classes (ES2 < 4%, ES2 4-8% and ES2 > 8%). The accuracy of ES2 in estimating mortality risk was assessed using the standardized mortality ratio (O/E ratio), ROC curves (AUC) and Hosmer-Lemeshow (HL) test for goodness-of-fit. Results: The overall observed mortality was 3.0% (predicted mortality ES2: 5.39%) with an observed/expected (O/E) ratio of 0.64 (confidential interval (CI): 0.49-0.89). In our population, ES2 showed a moderate discriminating power (AUC 0.65, 95%CI 0.56-0.72, p < 0.001; HL p = 0.798). Good accuracy was found in patients with ES2 < 4% (O/E ratio 0.54, 95%CI 0.23-1.20, AUC 0.75, p < 0.001, HL p = 0.999) and for patients with an age < 75 years (O/E ratio 0.98, 95%CI 0.45-1.96, AUC 0.76, p = 0.004, HL p = 0.762). Moderate discrimination was observed for ES2 in the estimation of long-term risk of mortality (AUC 0.64, 95%CI: 0.60-0.68, p < 0.001). Conclusions: EuroSCORE II showed good accuracy in patients with an age < 75 years and patients with ES2 < 4%, while overestimating risk in the other subgroups. A recalibration of the model should be taken into account based on the complexity of actual patients and impact of new technologies.
摘要：
背景：EuroSCOREII（ES2）是心脏手术前死亡率风险预测的可靠工具；然而，病人的年龄，外科手术的重量和可用的新设备可能会导致其准确性漂移。我们试图调查ES2性能与手术风险和晚期死亡率估计相关的患者主动脉瓣置换术（AVR）无缝合瓣膜。方法：在2012年至2021年之间，回顾性收集了来自六个欧洲中心的1126例单纯性主动脉瓣狭窄患者，这些患者通过无缝合瓣膜进行了AVR手术。根据EuroSCOREII风险等级将患者分为三组（ES2<4％，ES24-8%和ES2>8%)。使用标准化死亡率比（O/E比）评估ES2估计死亡风险的准确性，ROC曲线(AUC)和Hosmer-Lemeshow(HL)检验拟合优度。结果：总体观察死亡率为3.0％（预测死亡率ES2：5.39％），观察/预期（O/E）比为0.64（保密区间（CI）：0.49-0.89）。在我们的人口中，ES2显示中等辨别能力(AUC0.65,95CI0.56-0.72,p<0.001;HLp=0.798)。ES2<4％的患者（O/E比0.54，95CI0.23-1.20，AUC0.75，p<0.001，HLp=0.999）和年龄<75岁的患者（O/E比0.98，95CI0.45-1.96，AUC0.76，p=0.004，HLp=0.762）具有良好的准确性。ES2在估计长期死亡风险方面观察到中度区分(AUC0.64,95CI:0.60-0.68,p<0.001)。结论：EuroSCOREII在年龄<75岁和ES2<4％的患者中显示出良好的准确性，同时高估了其他亚组的风险。应根据实际患者的复杂性和新技术的影响考虑模型的重新校准。
