Prediction of Early Morbidity in Euroscore Ii and STS Score in Patients Undergoing Cabg Surgery

Q: What are the key findings of this study?

EuroSCORE II achieved higher sensitivity (73.9% vs 52.2%) and comparable overall accuracy (97.0% vs 96.3%) compared to the STS score for predicting early postoperative morbidity after CABG (p<0.001).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Coronary artery bypass grafting (CABG) (n=400). Intervention: EuroSCORE II (threshold >=4%) vs. Society of Thoracic Surgeons (STS) risk score (threshold >=4%). Primary outcome: Overall classification accuracy for early postoperative morbidity within 7 days after CABG (p=<0.001).

Q: What does this research mean for the field?

Both EuroSCORE II and the STS score demonstrate high specificity and overall classification accuracy for predicting early postoperative morbidity after CABG, with EuroSCORE II exhibiting higher sensitivity than the STS score. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Muhammad Saleem; Muhammad Awais Saeed; Syed Anees Ur Rehman Shah; Mohsin Ahmed; Muhammad Ahsan Fareed; Momina Arshad

doi:10.70034/ijmedph.2026.4.83

October 15, 2026International Journal of Medicine and Public HealthOpen Access

Prediction of Early Morbidity in Euroscore Ii and STS Score in Patients Undergoing Cabg Surgery

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Key result

EuroSCORE II shows ~22-point higher sensitivity than STS for early post-CABG morbidity.

P<0.001
n=400

Why the study?

EuroSCORE II and the Society of Thoracic Surgeons (STS) score are widely used cardiac surgical risk models for CABG, but their predictive performance for early postoperative morbidity may vary across populations and clinical settings.

Does preoperative EuroSCORE II compared with the STS score accurately predict early postoperative morbidity within 7 days in patients undergoing isolated CABG?

Study Design

Type

Observational (n=400)

Multicenter

No

Structured PICO

Does preoperative EuroSCORE II compared with the STS score accurately predict early postoperative morbidity within 7 days in patients undergoing isolated CABG?

P

Population

400 patients aged 20-70 years (mean age 53.2 years, 39.0% female) undergoing isolated coronary artery bypass grafting, excluding those with LVEF <=35%, pre-existing renal disease, COPD, or urgent acute MI, followed for 7 days postoperatively.

E

Exposure

Preoperative risk stratification using EuroSCORE II (positive prediction for early morbidity defined as score ≥4%)

C

Comparator

Preoperative risk stratification using the Society of Thoracic Surgeons (STS) score (positive prediction for early morbidity defined as score ≥4%)

O

Outcome

Early postoperative morbidity occurring within seven days after CABG (including renal dysfunction, neurological events such as stroke and transient ischemic attack, prolonged mechanical ventilation ≥24 hours, and oxygen saturation <95%)composite

Main Result

Absolute Event Rate: 97% vs 96.3%

p-value: p=<0.001

Limitations

Single-center study using purposive sampling, limiting external validity
Low number of early morbidity events (23 of 400 patients, 5.8%), limiting statistical power
Evaluated dichotomized scores (>=4% threshold) against early morbidity rather than EuroSCORE II's original operative mortality endpoint
Lack of formal calibration assessment (calibration plots, observed-to-expected ratios) and ROC curve discrimination analysis
Short 7-day follow-up period did not capture events occurring up to the conventional 30-day postoperative mark
Subgroup analyses were unadjusted and exploratory
Single-center study requiring larger multicentre studies for broader validation
Evaluated dichotomised predictions (≥4% threshold) rather than continuous predicted probabilities with formal calibration (observed-to-expected ratios) and discrimination (AUC/ROC) analyses
No multivariable adjustment was undertaken to determine whether clinical risk factors independently predicted morbidity
Low number of morbidity events (23 of 400 patients) and small cell sizes in subgroups (e.g., only 15 patients without hyperlipidemia) limited statistical power and caused sparse-data effects

Implication

In a Pakistani CABG cohort, both EuroSCORE II and STS scores demonstrated high specificity (>98%) and overall classification accuracy (>96%) for predicting 7-day postoperative morbidity, though EuroSCORE II provided higher sensitivity (73.9% vs 52.2%).

Abstract

Background: Accurate preoperative risk stratification is important for clinical decision-making, perioperative planning, and quality assessment in patients undergoing coronary artery bypass grafting (CABG). EuroSCORE II and the Society of Thoracic Surgeons (STS) score are widely used cardiac surgical risk models, but their predictive performance may vary across populations and clinical settings. This study compared the performance of EuroSCORE II and the STS score for predicting early postoperative morbidity in patients undergoing CABG. Materials and Methods: A prospective observational diagnostic-accuracy study was conducted at the Punjab Institute of Cardiology, Lahore, Pakistan, from February 2024 to February 2025. A total of 400 patients aged 20-70 years undergoing CABG were enrolled using purposive sampling. EuroSCORE II and STS risk scores were calculated preoperatively, and patients were followed for seven days after surgery to assess early postoperative morbidity. Predicted morbidity was compared with observed morbidity using 2 × 2 contingency tables. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall classification accuracy were calculated. Associations between early morbidity and demographic or clinical risk factors were also assessed, with statistical significance set at p<0.05. Results: The mean age of the study population was 53.23 ± 11.90 years, and 244 (61.0%) patients were male. Early postoperative morbidity occurred in 23 of 400 patients (5.8%). EuroSCORE II demonstrated a sensitivity of 73.9%, specificity of 98.4%, PPV of 73.9%, NPV of 98.4%, and overall accuracy of 97.0%. The STS score showed a sensitivity of 52.2%, specificity of 98.9%, PPV of 75.0%, NPV of 97.1%, and overall accuracy of 96.3%. Both scoring systems were significantly associated with observed morbidity (p<0.001). Early morbidity was significantly associated with hypertension (p=0.007), obesity (p<0.001), and hyperlipidemia on Fisher’s exact testing (p=0.048), whereas age, sex, diabetes mellitus, and smoking status were not significantly associated with the outcome. Conclusion: Both EuroSCORE II and the STS score demonstrated high specificity and overall classification accuracy for early postoperative morbidity after CABG. EuroSCORE II showed higher sensitivity, whereas STS demonstrated marginally higher specificity. These findings support the use of structured preoperative risk assessment while also emphasizing the need for larger multicentre studies with formal calibration and discrimination analyses before either model is used as a stand-alone predictor of early morbidity in this population.

Discussion

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Cite This Study

Saleem et al. (2026) conducted an observational in Coronary artery bypass grafting (CABG) (n=400). EuroSCORE II (threshold >=4%) vs. Society of Thoracic Surgeons (STS) risk score (threshold >=4%) was evaluated on Overall classification accuracy for early postoperative morbidity within 7 days after CABG (p=<0.001). EuroSCORE II achieved higher sensitivity (73.9% vs 52.2%) and comparable overall accuracy (97.0% vs 96.3%) compared to the STS score for predicting early postoperative morbidity after CABG (p<0.001).

synapsesocial.com/papers/6ae13d0f043bfbd6353327e0 https://doi.org/10.70034/ijmedph.2026.4.83

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Prediction of Early Morbidity in Euroscore Ii and STS Score in Patients Undergoing Cabg Surgery

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Prediction of Early Morbidity in Euroscore Ii and STS Score in Patients Undergoing Cabg Surgery

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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