背景:风险预测模型,如胸外科医师协会(STS)风险评分和欧洲心脏手术风险评估系统II(EuroSCOREII),推荐用于评估冠状动脉旁路移植术(CABG)的手术死亡率。然而,他们在巴西的表现值得怀疑。
目的:评估STS评分和EuroSCOREII在巴西参考中心分离的CABG中的表现。
方法:观察和前瞻性研究,包括2022年5月至2023年5月在DantePazzanesedeCardiologia研究所接受单独CABG的438例患者。通过区分(曲线下面积[AUC])和校准(观察/预期比[O/E]),将观察到的死亡率与预测的死亡率(STS评分和EuroSCOREII)进行比较。
结果:观察到的死亡率为4.3%(n=19),STS和EuroSCOREII估计为1.21%和2.74%,分别。STS(AUC=0.646;95%置信区间[CI]0.760-0.532)和EuroSCOREII(AUC=0.697;95%CI0.802-0.593)的区别性较差。北美模式没有校准(P<0.05),欧洲模式合理(O/E=1.59,P=0.056)。在分组中,EuroSCOREII的AUC为0.616(95%CI0.752-0.480)和0.826(95%CI0.991-0.661),在ACS和CAD患者中,STS的AUC分别为0.467(95%CI0.622-0.312)和0.855(95%CI1.0-0.706),分别,在稳定的患者中表现出良好的评分表现。
结论:预测模型在总样本中表现不佳,但EuroSCORE是优越的,特别是在选择性稳定的患者中,精度令人满意。
BACKGROUND: Risk prediction models, such as The Society of Thoracic Surgeons (STS) risk score and the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II), are recommended for assessing operative mortality in coronary artery bypass grafting (CABG). However, their performance is questionable in Brazil.
OBJECTIVE: To assess the performance of the STS score and EuroSCORE II in isolated CABG at a Brazilian reference center.
METHODS: Observationaland prospective study including 438 patients undergoing isolated CABG from May 2022-May 2023 at the Instituto Dante Pazzanese de Cardiologia. Observed mortality was compared with predicted mortality (STS score and EuroSCORE II) by discrimination (area under the curve [AUC]) and calibration (observed/expected ratio [O/E]) in the total sample and subgroups of stable coronary artery disease (CAD) and acute coronary syndrome (ACS).
RESULTS: Observed mortality was 4.3% (n=19) and estimated at 1.21% and 2.74% by STS and EuroSCORE II, respectively. STS (AUC=0.646; 95% confidence interva [CI] 0.760-0.532) and EuroSCORE II (AUC=0.697; 95% CI 0.802-0.593) presented poor discrimination. Calibration was absent for the North American mode (P<0.05) and reasonable for the European model (O/E=1.59, P=0.056). In the subgroups, EuroSCORE II had AUC of 0.616 (95% CI 0.752-0.480) and 0.826 (95% CI 0.991-0.661), while STS had AUC of 0.467 (95% CI 0.622-0.312) and 0.855 (95% CI 1.0-0.706) in ACS and CAD patients, respectively, demonstrating good score performance in stable patients.
CONCLUSIONS: The predictive models did not perform optimally in the total sample, but the EuroSCORE was superior, especially in elective stable patients, where accuracy was satisfactory.