Key result
HiriSCORE outperforms STS and EuroSCORE II in predicting high-risk CABG mortality with 0.74 AUC.
Why the study?
The performance of traditional risk scores is significantly limited for predicting mortality in high-risk cardiac surgery.
Does the HiriSCORE model improve mortality risk prediction compared to STS and EuroSCORE II in high-risk patients undergoing CABG?
Cross-Sectional (n=248)
Yes
Does the HiriSCORE model improve mortality risk prediction compared to STS and EuroSCORE II in high-risk patients undergoing CABG?
The HiriSCORE model provides more accurate mortality risk prediction than traditional STS and EuroSCORE II models in high-risk patients undergoing CABG.
May aid risk stratification in high-risk CABG; hypothesis-generating and requires prospective validation before practice change.
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.
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Goncharov et al. (2021) conducted a cross-sectional in High-risk patients undergoing coronary artery bypass grafting (n=248). HiriSCORE model vs. STS and EuroSCORE II (ESII) models was evaluated on Accuracy of mortality prediction (Area under the ROC curve) (95% CI 0.64-0.82). The HiriSCORE model accurately predicted mortality in high-risk patients undergoing coronary artery bypass grafting with an AUC of 0.74, outperforming the traditional STS and EuroSCORE II models.
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