Key result
The STS score and EuroSCORE II demonstrated good discrimination for mortality in minimally invasive cardiac surgery (AUC 0.86 and 0.90, respectively), but all three evaluated scores lacked adequate calibration.
Why the study?
The performance of the Society of Thoracic Surgeons score relative to other risk scores in minimally invasive cardiac surgery was not known.
Do the STS, EuroSCORE II, and ACEF scores accurately predict mortality in patients undergoing minimally invasive cardiac surgery?
Observational (n=4,751)
No
Do the STS, EuroSCORE II, and ACEF scores accurately predict mortality in patients undergoing minimally invasive cardiac surgery?
In patients undergoing minimally invasive cardiac surgery, the STS score provides acceptable discrimination and calibration for low-to-medium risk patients, whereas EuroSCORE II and ACEF consistently overestimate mortality.
May warrant caution applying standard scores to minimally invasive cardiac surgery; leaves open need for recalibrated, procedure-specific models.
Objective The Society of Thoracic Surgeons score performance relative to other scores in minimally invasive cardiac surgery is not known. Methods Patients who underwent surgery from 2003 to 2018 identified from database. Additional variables included for STS score calculation, EuroSCORE II and age, creatinine and ejection fraction score calculation. Results A total of 4751 patients were identified from main database. There were actual 47 (0.99%) hospitals deaths. The mean STS score predicted mortality were 2.0 ± 2.1. Discriminatory power was uniformly good (for STS Mortality: area under curve, 0.86; 95% confidence interval, 0.81 - 0.91). The mean EuroSCORE II predicted mortality were 2.9 ± 3.8. Discriminatory power was uniformly good similar to that of STS (for EuroSCORE II Mortality: area under curve, 0.9; 95% confidence interval, 0.86 - 0.93). The mean ACEF predicted mortality were 2.5 ± 2.3. Discriminatory power was uniformly good but inferior to that of STS and EuroSCORE II (for ACEF Mortality: area under curve, 0.72; 95% confidence interval, 0.65 - 0.8). Calibration pattern for STS score was the best for of mortality prediction (p < 0.01), EuroSCORE II and ACEF were constantly overestimating mortality (respectively, p < 0.01 and p < 0.01). scores. Conclusions The STS score has acceptable discrimination power for this sub-population. However, it is not calibrated for the the subset. EuroSCORE II is has good discrimination power, but not calibrate for the this subset of patients. ACEF score had similar performance to EuroSCORE. No algorithm seems suitable for accurate risk estimation.
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Margaryan et al. (2020) conducted an observational in Minimally invasive cardiac surgery (n=4,751). STS score, EuroSCORE II, and ACEF score vs. Observed mortality was evaluated on Discriminatory power for mortality (STS score) (AUC 0.86, 95% CI 0.81-0.91). The STS score and EuroSCORE II demonstrated good discrimination for mortality in minimally invasive cardiac surgery (AUC 0.86 and 0.90, respectively), but all three evaluated scores lacked adequate calibration.
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