Key result
The Adult Congenital Heart Surgery (ACHS) score significantly predicted hospital mortality with an area under the curve of 0.706, though it had lower predictive value than the ABC and STAT scores.
Why the study?
There was no approved risk stratification for adult congenital heart surgery, prompting evaluation of pediatric risk stratification tools alongside the newly developed Adult Congenital Heart Surgery (ACHS) score in adults.
Observational (n=205)
No
Effect estimate: AUC 0.706 (95% CI 0.538-0.874)
p-value: p=0.037
ACHS score shows moderate mortality prediction in adults; leaves open routine adoption pending larger validation studies.
Objectives: Currently, there is no approved risk stratification for adult congenital heart surgery; accordingly, this study aimed to evaluate risk stratification for congenital heart surgery in the pediatric age in terms of its prognostic value in adult patients as well as the effectiveness of the newly developed Adult Congenital Heart Surgery (ACHS) score in this patient group. Patients and methods: A total of 205 patients (115 males, 90 females; mean age: 25.0±11.4 years; range, 18 to 65 years) operated on due to congenital heart disease between January 1, 2011, and August 1, 2019, were studied retrospectively. Aristotle Basic Complexity (ABC) score, Society of Thoracic Surgery European Association for Cardiothoracic Surgery (STAT) score, and ACHS score were evaluated. Receiver operating characteristic (ROC) curves were created to evaluate the ability of scoring systems to predict mortality. Results: The mortality rate was 4.4% (n=9). For mortality, areas under the ROC curve were 0.89, 0.89, and 0.70 for ABC, STAT, and ACHS scores, respectively. The mean ACHS score was 0.42±0.34. The cut-off point of the ACHS score was identified as 0.7 and above. The specificity of the cut-off value of 0.7 regarding the ACHS score was 94.39%. Adult Congenital Heart Surgery scores were found to be statistically high in patients with mortality (p=0.037; p<0.05). Conclusion: Adult Congenital Heart Surgery scores had higher specificity in determining mortality in cases with an ACHS score of 0.7 and above. The ACHS score could also be used to determine the expected mortality rate, similar to the ABC and STAT scores.
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Berra Zümrüt Tan Recep (2022) conducted an observational in Adult congenital heart defects (n=205). Adult Congenital Heart Surgery (ACHS) score vs. ABC and STAT scores was evaluated on Hospital mortality prediction (Area Under the Curve) (AUC 0.706, 95% CI 0.538-0.874, p=0.037). The Adult Congenital Heart Surgery (ACHS) score significantly predicted hospital mortality with an area under the curve of 0.706, though it had lower predictive value than the ABC and STAT scores.
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