Why the study?
Accurate risk prediction in patients undergoing revascularisation is essential, prompting assessment of Society of Thoracic Surgeons risk models in patients with left main coronary artery disease undergoing CABG or PCI-EES.
Does the STS risk score accurately predict perioperative mortality, stroke, and renal failure in patients with LMCAD undergoing PCI or CABG?
RCT (n=1,858)
Does the STS risk score accurately predict perioperative mortality, stroke, and renal failure in patients with LMCAD undergoing PCI or CABG?
Answers are grounded in this paper and cite their sources.
The STS risk score performs well for predicting perioperative mortality and renal failure after CABG but is inadequate for predicting these outcomes after PCI in patients with left main coronary artery disease.
AIMS: Accurate risk prediction in patients undergoing revascularisation is essential. We aimed to assess the predictive performance of Society of Thoracic Surgeons (STS) risk models in patients with left main coronary artery disease (LMCAD) undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention with everolimus-eluting stents (PCI-EES). METHODS AND RESULTS: The predictive performance of STS risk models for perioperative mortality, stroke and renal failure was evaluated for their discriminative ability (C statistic) and calibration (Hosmer-Lemeshow goodness-of-fit-test; χ2 and p-values) among patients with LMCAD undergoing PCI-EES (n=935) and CABG (n=923) from the randomised EXCEL trial. STS risk scores, in CABG patients, showed good discrimination for 30-day mortality and average discrimination for stroke (C statistic 0.730 and 0.629, respectively) with average calibration. For PCI, STS risk scores had no discrimination for mortality (C statistic 0.507), yet good discrimination (C statistic 0.751) and calibration for stroke. The predictive performance for renal failure was good for CABG (C statistic 0.82), yet poor for PCI (C statistic 0.59). CONCLUSIONS: In selected patients with LMCAD from the EXCEL trial, STS risk models showed good predictive performance for CABG yet lacked predictive performance for PCI for perioperative mortality and renal failure. The STS stroke risk model was surprisingly more discriminating in PCI compared to CABG. Improved and procedure-specific risk prediction instruments are needed to accurately estimate adverse events after LMCAD revascularisation by CABG and PCI. ClinicalTrials.gov Identifier: NCT01205776.
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Thuijs et al. (2020) conducted an RCT in left main coronary artery disease (LMCAD) (n=1,858). Society of Thoracic Surgeons (STS) risk models was evaluated on Predictive performance (C statistic) of STS risk models for perioperative mortality, stroke and renal failure.
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