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Rodríguez Lima DR, Rodríguez Aparicio EE, Otálora González L, Hernández DC, González-Muñoz A. Performance of the EuroSCORE in coronary artery bypass graft in Colombia, a middle-income country: A retrospective cohort. World J Cardiol 2025; 17:100506. [DOI: 10.4330/wjc.v17.i3.100506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Revised: 10/24/2024] [Accepted: 03/13/2025] [Indexed: 03/21/2025] Open
Abstract
BACKGROUND The EuroSCORE II is a globally accepted tool for predicting mortality in patients undergoing cardiac surgery. However, the discriminative ability of this tool in non-European populations may be inadequate, limiting its use in other regions.
AIM To evaluate the performance of EuroSCORE II in patients undergoing coronary artery bypass graft (CABG) surgery at a hospital in Bogotá, Colombia.
METHODS An observational, analytical study of a retrospective cohort was designed. All patients admitted to Hospital Universitario Mayor Méderi who underwent CABG between December 2015 and May 2020 were included. In-hospital mortality was the primary outcome evaluated. Furthermore, the performance of EuroSCORE II was assessed in this population.
RESULTS A total of 1009 patients were included [median age 66 years IQR = 59-72, 78.2% men]. The overall in-hospital mortality was 5.5% (n = 56). The median mortality predicted using EuroSCORE II was 1.29 (IQR = 0.92-2.11). Non-ST-segment elevation myocardial infarction was the most common preoperative diagnosis (54.1%), followed by ST-segment elevation myocardial infarction (19.1%) and unstable angina (14.3%). Urgent surgery was performed in 87.3% of the patients (n = 881). Mortality rates in each group were as follows: Low risk 6.0% (n = 45, observed-to-expected (O/E) ratio, 5.6), moderate risk 3.0% (n = 5, O/E ratio 1.17), high risk 5.0% (n = 4, O/E ratio 0.94), and very high risk 7.6% (n = 2, O/E ratio 0.71). The overall O/E ratio was 4.2. The area under the curve of EuroSCORE II was 0.55 [95% confidence interval: 0.48-0.63]
CONCLUSION EuroSCORE II exhibited poor performance in this population owing to its low discriminative ability. This finding may be explained by the fact that the population comprised older individuals with higher ventricular function impairment. Moreover, unlike the population in which this tool was originally developed, most patients were not electively admitted for the surgery.
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Affiliation(s)
- David Rene Rodríguez Lima
- Department of Critical Care, Hospital Universitario Mayor - Méderi, Bogota 111321, Colombia
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogota 111321, Colombia
| | | | - Laura Otálora González
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogota 111321, Colombia
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Sinha S, Dong T, Dimagli A, Judge A, Angelini GD. A machine learning algorithm-based risk prediction score for in-hospital/30-day mortality after adult cardiac surgery. Eur J Cardiothorac Surg 2024; 66:ezae368. [PMID: 39374541 PMCID: PMC11522872 DOI: 10.1093/ejcts/ezae368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 09/14/2024] [Accepted: 10/03/2024] [Indexed: 10/09/2024] Open
Abstract
OBJECTIVES A study of the performance of in-hospital/30-day mortality risk prediction models using an alternative machine learning algorithm (XGBoost) in adults undergoing cardiac surgery. METHODS Retrospective analyses of prospectively routinely collected data on adult patients undergoing cardiac surgery in the UK from January 2012 to March 2019. Data were temporally split 70:30 into training and validation subsets. Independent mortality prediction models were created using sequential backward floating selection starting with 61 variables. Assessments of discrimination, calibration, and clinical utility of the resultant XGBoost model with 23 variables were then conducted. RESULTS A total of 224,318 adults underwent cardiac surgery during the study period with a 2.76% (N = 6,100) mortality. In the testing cohort, there was good discrimination (area under the receiver operator curve 0.846, F1 0.277) and calibration (especially in high-risk patients). Decision curve analysis showed XGBoost-23 had a net benefit till a threshold probability of 60%. The most important variables were the type of operation, age, creatinine clearance, urgency of the procedure and the New York Heart Association score. CONCLUSIONS Feature-selected XGBoost showed good discrimination, calibration and clinical benefit when predicting mortality post-cardiac surgery. Prospective external validation of a XGBoost-derived model performance is warranted.
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Affiliation(s)
- Shubhra Sinha
- Department of Cardiac Surgery, Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK
| | - Tim Dong
- Department of Cardiac Surgery, Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK
| | - Arnaldo Dimagli
- Department of Cardiac Surgery, Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK
| | - Andrew Judge
- Department of Cardiac Surgery, Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Gianni D Angelini
- Department of Cardiac Surgery, Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK
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Dong W, Wan EYF, Fong DYT, Tan KCB, Tsui WWS, Hui EMT, Chan KH, Fung CSC, Lam CLK. Development and validation of 10-year risk prediction models of cardiovascular disease in Chinese type 2 diabetes mellitus patients in primary care using interpretable machine learning-based methods. Diabetes Obes Metab 2024; 26:3969-3987. [PMID: 39010291 DOI: 10.1111/dom.15745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 06/03/2024] [Accepted: 06/11/2024] [Indexed: 07/17/2024]
Abstract
AIM To develop 10-year cardiovascular disease (CVD) risk prediction models in Chinese patients with type 2 diabetes mellitus (T2DM) managed in primary care using machine learning (ML) methods. METHODS In this 10-year population-based retrospective cohort study, 141 516 Chinese T2DM patients aged 18 years or above, without history of CVD or end-stage renal disease and managed in public primary care clinics in 2008, were included and followed up until December 2017. Two-thirds of the patients were randomly selected to develop sex-specific CVD risk prediction models. The remaining one-third of patients were used as the validation sample to evaluate the discrimination and calibration of the models. ML-based methods were applied to missing data imputation, predictor selection, risk prediction modelling, model interpretation, and model evaluation. Cox regression was used to develop the statistical models in parallel for comparison. RESULTS During a median follow-up of 9.75 years, 32 445 patients (22.9%) developed CVD. Age, T2DM duration, urine albumin-to-creatinine ratio (ACR), estimated glomerular filtration rate (eGFR), systolic blood pressure variability and glycated haemoglobin (HbA1c) variability were the most important predictors. ML models also identified nonlinear effects of several predictors, particularly the U-shaped effects of eGFR and body mass index. The ML models showed a Harrell's C statistic of >0.80 and good calibration. The ML models performed significantly better than the Cox regression models in CVD risk prediction and achieved better risk stratification for individual patients. CONCLUSION Using routinely available predictors and ML-based algorithms, this study established 10-year CVD risk prediction models for Chinese T2DM patients in primary care. The findings highlight the importance of renal function indicators, and variability in both blood pressure and HbA1c as CVD predictors, which deserve more clinical attention. The derived risk prediction tools have the potential to support clinical decision making and encourage patients towards self-care, subject to further research confirming the models' feasibility, acceptability and applicability at the point of care.
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Affiliation(s)
- Weinan Dong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China
- Advanced Data Analytics for Medical Science (ADAMS) Limited, Hong Kong, China
| | | | | | - Wendy Wing-Sze Tsui
- Department of Family Medicine & Primary Healthcare, Hong Kong West Cluster, Hosptial Authority, Hong Kong, China
| | - Eric Ming-Tung Hui
- Department of Family Medicine, New Territories East Cluster, Hospital Authority, Hong Kong, China
| | - King Hong Chan
- Department of Family Medicine & General Out-patient Clinics, Kowloon Central Cluster, Hospital Authority, Hong Kong, China
| | - Colman Siu Cheung Fung
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
- Department of Family Medicine, The University of Hong Kong Shenzhen Hospital, Shenzhen, China
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Gatti G, Fiore A, Ismail M, Dralov A, Saade W, Costantino V, Barbati G, Lim P, Lepeule R, Franzese I, Minati A, Sponga S, Fabris E, Luzzati R, Sinagra G, Biondi-Zoccai G, Frati G, Perrotti A, Vendramin I, Mazzaro E. Prediction of 30-day mortality after surgery for infective endocarditis using risk scores: Insights from a European multicenter comparative validation study. Am Heart J 2024; 275:108-118. [PMID: 38848985 DOI: 10.1016/j.ahj.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 05/30/2024] [Accepted: 05/31/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND It remains unclear today whether risk scores created specifically to predict early mortality after cardiac operations for infective endocarditis (IE) outperform or not the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II). METHODS Perioperative data and outcomes from a European multicenter series of patients undergoing surgery for definite IE were retrospectively reviewed. Only the cases with known pathogen and without missing values for all considered variables were retained for analyses. A comparative validation of EuroSCORE II and 5 specific risk scores for early mortality after surgery for IE-(1) STS-IE (Society of Thoracic Surgeons for IE); (2) PALSUSE (Prosthetic valve, Age ≥70, Large intracardiac destruction, Staphylococcus spp, Urgent surgery, Sex (female), EuroSCORE ≥10); (3) ANCLA (Anemia, New York Heart Association class IV, Critical state, Large intracardiac destruction, surgery on thoracic Aorta); (4) AEPEI II (Association pour l'Étude et la Prévention de l'Endocardite Infectieuse II); (5) APORTEI (Análisis de los factores PROnósticos en el Tratamiento quirúrgico de la Endocarditis Infecciosa)-was carried out using calibration plot and receiver-operating characteristic curve analysis. Areas under the curve (AUCs) were compared 1:1 according to the Hanley-McNeil's method. The agreement between APORTEI score and EuroSCORE II of the 30-day mortality prediction after surgery was also appraised. RESULTS A total of 1,012 patients from 5 European university-affiliated centers underwent 1,036 cardiac operations, with a 30-day mortality after surgery of 9.7%. All IE-specific risk scores considered achieved better results than EuroSCORE II in terms of calibration; AEPEI II and APORTEI score showed the best performances. Despite poor calibration, EuroSCORE II overcame in discrimination every specific risk score (AUC, 0.751 vs 0.693 or less, P = .01 or less). For a higher/lesser than 20% expected mortality, the agreement of prediction between APORTEI score and EuroSCORE II was 86%. CONCLUSION EuroSCORE II discrimination for 30-day mortality after surgery for IE was higher than 5 established IE-specific risk scores. AEPEI II and APORTEI score showed the best results in terms of calibration.
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Affiliation(s)
- Giuseppe Gatti
- Department of Cardio-Thoraco-Vascular, University of Trieste, Trieste, Italy.
| | - Antonio Fiore
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Maria Ismail
- Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz and University of Franche-Comté, Besançon, France
| | - Andriy Dralov
- Department of Cardiac Surgery, Ospedale Santa Maria della Misericordia, Udine, Italy
| | - Wael Saade
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, La Sapienza University, Rome, Italy
| | | | - Giulia Barbati
- Department of Medical Sciences, Biostatistics Unit, University of Trieste, Trieste, Italy
| | - Pascal Lim
- Department of Cardiology, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Faculté de Santé, Université de Paris Est, Créteil, France
| | - Raphael Lepeule
- Unitée Transversale de Traitement des Infections, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Ilaria Franzese
- Department of Cardio-Thoraco-Vascular, University of Trieste, Trieste, Italy
| | - Alessandro Minati
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, La Sapienza University, Rome, Italy
| | - Sandro Sponga
- Department of Cardiac Surgery, Ospedale Santa Maria della Misericordia, Udine, Italy
| | - Enrico Fabris
- Department of Cardio-Thoraco-Vascular, University of Trieste, Trieste, Italy
| | - Roberto Luzzati
- Department of Infective Diseases, University of Trieste, Trieste, Italy
| | - Gianfranco Sinagra
- Department of Cardio-Thoraco-Vascular, University of Trieste, Trieste, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical Surgical Sciences and Biotechnologies, La Sapienza University, Rome, Italy; Cardiology Unit, Santa Maria Goretti Hospital, Latina, Italy
| | - Giacomo Frati
- Department of Medical Surgical Sciences and Biotechnologies, La Sapienza University, Rome, Italy; Department of Angio-Cardio-Neurology, IRCCS Neuromed, Pozzilli, Italy
| | - Andrea Perrotti
- Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz and University of Franche-Comté, Besançon, France
| | - Igor Vendramin
- Department of Cardiac Surgery, Ospedale Santa Maria della Misericordia, Udine, Italy
| | - Enzo Mazzaro
- Department of Cardio-Thoraco-Vascular, University of Trieste, Trieste, Italy
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Kuźma Ł, Kowalewski M, Wańha W, Dąbrowski EJ, Jasiński M, Widenka K, Deja M, Bartuś K, Hirnle T, Wojakowski W, Lorusso R, Tobota Z, Maruszewski BJ, Suwalski P. Validation of EuroSCORE II in atrial fibrillation heart surgery patients from the KROK Registry. Sci Rep 2023; 13:13024. [PMID: 37563207 PMCID: PMC10415263 DOI: 10.1038/s41598-023-39983-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023] Open
Abstract
The study aimed to validate the European System for Cardiac Operative Risk Evaluation score (EuroSCORE II) in patients with atrial fibrillation (AF). All data were retrieved from the National Registry of Cardiac Surgery Procedures (KROK). EuroSCORE II calibration and discrimination performance was evaluated. The final cohort consisted of 44,172 patients (median age 67, 30.8% female, 13.4% with AF). The in-hospital mortality rate was 4.14% (N = 1830), and 5.21% (N = 2303) for 30-day mortality. EuroSCORE II significantly underestimated mortality in mild- and moderate-risk populations [Observed (O):Expected (E)-1.1, 1.16). In the AF subgroup, it performed well [O:E-0.99), whereas in the very high-risk population overestimated mortality (O:E-0.9). EuroSCORE II showed better discrimination in AF (-) [area under curve (AUC) 0.805, 95% CI 0.793-0.817)] than in AF (+) population (AUC 0.791, 95%CI 0.767-0.816), P < 0.001. The worst discriminative performance for the AF (+) group was for coronary artery bypass grafting (CABG) (AUC 0.746, 95% CI 0.676-0.817) as compared with AF (-) population (AUC 0.798, 95% CI 0.774-0.822), P < 0.001. EuroSCORE II is more accurate for patients with AF. However, it underestimated mortality rates for low-to-moderate-risk patients and had a lower ability to distinguish between high- and low-risk patients with AF, particularly in those undergoing coronary artery bypass grafting.
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Affiliation(s)
- Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Mariusz Kowalewski
- Clinical Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Warsaw, Poland.
- Thoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland.
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Centre Maastricht (CARIM), Maastricht, The Netherlands.
| | - Wojciech Wańha
- Thoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Emil Julian Dąbrowski
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Marek Jasiński
- Department and Clinic of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Kazimierz Widenka
- Clinical Department of Cardiac Surgery, District Hospital No. 2, University of Rzeszów, Rzeszów, Poland
| | - Marek Deja
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
- Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland
| | - Krzysztof Bartuś
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Tomasz Hirnle
- Department of Cardiosurgery, Medical University of Bialystok, Bialystok, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Centre Maastricht (CARIM), Maastricht, The Netherlands
| | - Zdzisław Tobota
- Department of Pediatric Cardiothoracic Surgery, The Children's Memorial Health Institute, Warsaw, Poland
| | - Bohdan J Maruszewski
- Department of Pediatric Cardiothoracic Surgery, The Children's Memorial Health Institute, Warsaw, Poland
| | - Piotr Suwalski
- Clinical Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Warsaw, Poland
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Del Val D, Panagides V, Mestres CA, Miró JM, Rodés-Cabau J. Infective Endocarditis After Transcatheter Aortic Valve Replacement: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 81:394-412. [PMID: 36697140 DOI: 10.1016/j.jacc.2022.11.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 01/25/2023]
Abstract
Infective endocarditis (IE) is a rare but serious complication following transcatheter aortic valve replacement (TAVR). Despite substantial improvements in the TAVR procedure (less invasive) and its expansion to younger and healthier patients, the incidence of IE after TAVR remains stable, with incidence rates similar to those reported after surgical aortic valve replacement. Although IE after TAVR is recognized as a subtype of prosthetic valve endocarditis, this condition represents a particularly challenging scenario given its unique clinical and microbiological profile, the high incidence of IE-related complications, the uncertain role of cardiac surgery, and the dismal prognosis in most patients with TAVR-IE. The number of TAVR procedures is expected to grow exponentially in the coming years, increasing the number of patients at risk of developing this life-threatening complication. Therefore, a detailed understanding of this disease and its complications will be essential to improve clinical outcomes.
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Affiliation(s)
- David Del Val
- Hospital Universitario de La Princesa, Madrid, Spain; Instituto de Investigación Sanitaria, Hospital Universitario de La Princesa, CIBERCV, Madrid, Spain; Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Vassili Panagides
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Carlos A Mestres
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
| | - José M Miró
- Infectious Diseases Service, Hospital Clinic-L'Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Clínic Barcelona, Barcelona, Spain.
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Luo L, Huang S, Liu C, Liu Q, Dong S, Yue Y, Liu K, Huang L, Wang S, Li H, Zheng S, Wu Z. Machine Learning-Based Risk Model for Predicting Early Mortality After Surgery for Infective Endocarditis. J Am Heart Assoc 2022; 11:e025433. [PMID: 35656984 PMCID: PMC9238722 DOI: 10.1161/jaha.122.025433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Abstract
Background The early mortality after surgery for infective endocarditis is high. Although risk models help identify patients at high risk, most current scoring systems are inaccurate or inconvenient. The objective of this study was to construct an accurate and easy-to-use prediction model to identify patients at high risk of early mortality after surgery for infective endocarditis. Methods and Results A total of 476 consecutive patients with infective endocarditis who underwent surgery at 2 centers were included. The development cohort consisted of 276 patients. Eight variables were selected from 89 potential predictors as input of the XGBoost model to train the prediction model, including platelet count, serum albumin, current heart failure, urine occult blood ≥(++), diastolic dysfunction, multiple valve involvement, tricuspid valve involvement, and vegetation >10 mm. The completed prediction model was tested in 2 separate cohorts for internal and external validation. The internal test cohort consisted of 125 patients independent of the development cohort, and the external test cohort consisted of 75 patients from another center. In the internal test cohort, the area under the curve was 0.813 (95% CI, 0.670-0.933) and in the external test cohort the area under the curve was 0.812 (95% CI, 0.606-0.956). The area under the curve was significantly higher than that of other ensemble learning models, logistic regression model, and European System for Cardiac Operative Risk Evaluation II (all, P<0.01). This model was used to develop an online, open-access calculator (http://42.240.140.58:1808/). Conclusions We constructed and validated an accurate and robust machine learning-based risk model to predict early mortality after surgery for infective endocarditis, which may help clinical decision-making and improve outcomes.
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Affiliation(s)
- Li Luo
- Department of Cardiac SurgeryThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouP. R. China
| | - Sui‐qing Huang
- Department of Cardiac SurgeryThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouP. R. China
| | - Chuang Liu
- School of Computer Science and TechnologyXidian UniversityXi’anP. R. China
| | - Quan Liu
- Department of Cardiac SurgeryThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouP. R. China
| | - Shuohui Dong
- Department of General SurgeryQianfoshan HospitalShandong UniversityJinanP. R. China
| | - Yuan Yue
- Department of Cardiac SurgeryThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouP. R. China
| | - Kai‐zheng Liu
- Department of Cardiac SurgeryThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouP. R. China
| | - Lin Huang
- Department of Cardiac SurgeryThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouP. R. China
| | - Shun‐jun Wang
- Department of Cardiac SurgeryThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouP. R. China
| | - Hua‐yang Li
- Department of Cardiac SurgeryThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouP. R. China
| | - Shaoyi Zheng
- Department of Cardiovascular SurgeryNanfang HospitalSouthern Medical UniversityGuangzhouP. R. China
| | - Zhong‐kai Wu
- Department of Cardiac SurgeryThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouP. R. China
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Bouleti C, Michel M, Jobbe Duval A, Hemery T, Nicol PP, Didier R, Zeyons F, Zouaghi O, Tchetche D, Delon C, Delomez M, Dibie A, Attias D, Le Breton H, Cormier B, Obadia JF, Tribouilloy C, Lansac E, Chevreul K, Naccache N, Eltchaninoff H, Gilard M, Iung B. Current treatment of symptomatic aortic stenosis in elderly patients: Do risk scores really matter after 80 years of age? Arch Cardiovasc Dis 2021; 114:624-633. [PMID: 34600866 DOI: 10.1016/j.acvd.2021.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/28/2021] [Accepted: 06/10/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND According to the guidelines, surgical aortic valve replacement (SAVR) is recommended in patients at low surgical risk (EuroSCORE II<4%), whereas for other patients, the decision between transcatheter aortic valve implantation (TAVI) and surgery should be made by the Heart Team, with TAVI being favoured in elderly patients. AIM The RAC prospective multicentre survey assessed the respective contributions of age and surgical risk scores in therapeutic decision making in elderly patients with severe symptomatic aortic stenosis. METHODS In September and October 2016, 1049 consecutive patients aged ≥ 75 years were included in 32 centres with on-site TAVI and surgical facilities. The primary endpoint was the decision between medical management, TAVI or SAVR. RESULTS Mean age was 84±5 years and 53% of patients were female. The surgical risk was classified as high (EuroSCORE II>8%) in 18% of patients, intermediate (EuroSCORE II 4-8%) in 34% and low (EuroSCORE II≤4%) in 48%. TAVI was preferred in 71% of patients, SAVR in 19% and medical treatment in 10%. The choice of TAVI over SAVR was associated with older age (P<0.0001) and a higher EuroSCORE II (P=0.008). However, the weight of EuroSCORE II in therapeutic decision making markedly decreased after the age of 80 years. Indeed, 77% of patients aged ≥ 80 years were referred for TAVI, despite a low estimated surgical risk. CONCLUSIONS The impact of risk scores depends strongly on age, and decreases considerably after 80 years, most patients being referred for TAVI, independent of their estimated surgical risk. Despite medical advancements, 10% of patients were still denied any intervention.
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Affiliation(s)
- Claire Bouleti
- CIC Inserm 1402, Cardiology Department, Poitiers University Hospital, Poitiers University, 2, rue de la Milétrie, 86000 Poitiers, France.
| | - Morgane Michel
- ECEVE UMR 1123, Inserm, Hôpital Robert-Debré, URC Eco, Hotel-Dieu, AP-HP, 75019 Paris, France
| | | | | | | | | | | | | | | | | | | | - Alain Dibie
- Institut Mutualiste Montsouris, 75014 Paris, France
| | - David Attias
- Centre Cardiologique du Nord, 93200 Saint-Denis, France
| | | | | | | | | | | | - Karine Chevreul
- ECEVE UMR 1123, Inserm, Hôpital Robert-Debré, URC Eco, Hotel-Dieu, AP-HP, 75019 Paris, France
| | - Nicole Naccache
- Commission des Registres, French Society of Cardiology, Paris, France
| | | | | | - Bernard Iung
- Bichat Hospital, DHU Fire, Université de Paris, AP-HP, 75018 Paris, France
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Grant SW, Kendall S, Goodwin AT, Cooper G, Trivedi U, Page R, Jenkins DP. Trends and outcomes for cardiac surgery in the United Kingdom from 2002 to 2016. JTCVS OPEN 2021; 7:259-269. [PMID: 36003724 PMCID: PMC9390523 DOI: 10.1016/j.xjon.2021.02.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 12/13/2022]
Abstract
Objectives Cardiac surgery has evolved significantly since the turn of the century. The objective of this study was to investigate trends in cardiac surgery activity and outcomes in the United Kingdom utilizing a mandatory national cardiac surgical clinical database in the context of a comprehensive public health care system (ie, the UK National Health Service). Methods Data for all cardiac surgery procedures performed between 2002 and 2016 were extracted from the UK National Adult Cardiac Surgery Audit database. Data are validated and cleaned using reproducible algorithms. Trends in activity and outcomes were analyzed by fiscal year using linear regression. Results A total of 534,067 procedures were performed during the study period with the number of cases per year peaking in 2008/2009 at 41,426. Despite an increase in patient age and mean logistic European System for Cardiac Operative Risk Evaluation score, the in-hospital mortality rate for all cardiac surgery has fallen from 4.0% to 2.8% (P < .001). The number of isolated coronary artery bypass graft procedures has steadily declined but the total number of valve procedures has steadily increased (both P values < .001). The number of thoracic aortic procedures performed each year has doubled (P < .001), but the incidence of redo procedures has steadily declined. The proportion of emergency and salvage procedures has remained stable. Conclusions This study, which covers all cardiac surgery procedures performed in the United Kingdom for fiscal years between 2002 and 2016, demonstrates that despite an increase in patient risk profile, there has been a consistent reduction in in-hospital mortality. A number of other markers associated with quality have also improved.
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Affiliation(s)
- Stuart W Grant
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Simon Kendall
- James Cook University Hospital, Middlesbrough, United Kingdom
| | | | - Graham Cooper
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Uday Trivedi
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Richard Page
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - David P Jenkins
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
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10
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Goncharov M, Mejia OAV, Perez de Souza Arthur C, Orlandi BMM, Sousa A, Praça Oliveira MA, Atik FA, Coelho Segalote R, Gradim Tiveron M, Melo de Barros e Silva PG, Arruda Nakazone M, Ferreira Lisboa LA, Oliveira Dallan LA, Zheng Z, Hu S, Biscegli Jatene F. Mortality risk prediction in high-risk patients undergoing coronary artery bypass grafting: Are traditional risk scores accurate? PLoS One 2021; 16:e0255662. [PMID: 34343224 PMCID: PMC8330943 DOI: 10.1371/journal.pone.0255662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/21/2021] [Indexed: 12/13/2022] Open
Abstract
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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Affiliation(s)
- Maxim Goncharov
- Department of Cardiovascular Surgery, Instituto do Coração, University of São Paulo, São Paulo, Brazil
| | - Omar Asdrúbal Vilca Mejia
- Department of Cardiovascular Surgery, Instituto do Coração, University of São Paulo, São Paulo, Brazil
- Department of Cardiovascular Surgery, Hospital Samaritano Paulista, São Paulo, Brazil
| | | | | | - Alexandre Sousa
- Department of Cardiovascular Surgery, Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | | | - Fernando Antibas Atik
- Department of Cardiovascular Surgery, Instituto de Cardiologia do Distrito Federal, Brasília, Brazil
| | - Rodrigo Coelho Segalote
- Department of Cardiovascular Surgery, Instituto Nacional de Cardiologia do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcos Gradim Tiveron
- Department of Cardiovascular Surgery, Hospital Santa Casa de Misericórdia de Marília, Marília, Brazil
| | | | - Marcelo Arruda Nakazone
- Department of Cardiovascular Surgery, Hospital de Base de São José do Rio Preto, São José do Rio Preto, Brazil
| | | | | | - Zhe Zheng
- Department of Cardiovascular Surgery, Fuwai Hospital, Beijing, China
| | - Shengshou Hu
- Department of Cardiovascular Surgery, Fuwai Hospital, Beijing, China
| | - Fabio Biscegli Jatene
- Department of Cardiovascular Surgery, Instituto do Coração, University of São Paulo, São Paulo, Brazil
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11
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Pittams AP, Iddawela S, Zaidi S, Tyson N, Harky A. Scoring Systems for Risk Stratification in Patients Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2021; 36:1148-1156. [PMID: 33836964 DOI: 10.1053/j.jvca.2021.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/17/2021] [Accepted: 03/02/2021] [Indexed: 11/11/2022]
Abstract
Cardiac surgery is associated with significant mortality rates. Careful selection of surgical candidates is, therefore, vital to optimize morbidity and mortality outcomes. Risk scores can be used to inform this decision-making process. The European System for Cardiac Operative Risk Evaluation Score and the Society of Thoracic Surgeons score are among the most commonly used risk scores. There are many other scoring systems in existence; however, no perfect scoring system exists, therefore, additional research is needed as clinicians strive toward a more idealized risk stratification model. The purpose of this review is to discuss the advantages and limitations of some of the most commonly used risk stratification systems and use this to determine what an ideal scoring system might look like. This includes not only the generalizability of available scores but also their ease of use and predictive power.
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Affiliation(s)
- Ashleigh P Pittams
- Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Sashini Iddawela
- Good Hope Hospital, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Sara Zaidi
- King's College London School of Medicine, London, UK
| | - Nathan Tyson
- Department of Cardiac Surgery, Trent Cardiac Centre, Nottingham, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK; Department of Integrative Biology, Faculty of Health and Life Science, University of Liverpool, Liverpool, UK; Liverpool Centre of Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, UK.
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12
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Subramani S. The current status of EuroSCORE II in predicting operative mortality following cardiac surgery. Ann Card Anaesth 2020; 23:256-257. [PMID: 32687077 PMCID: PMC7559946 DOI: 10.4103/aca.aca_32_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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13
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Gatti G, Chocron S, Obadia JF, Duval X, Iung B, Alla F, Chirouze C, Lecompte T, Hoen B, Delahaye F, Tattevin P, Le Moing V, Perrotti A. Using surgical risk scores in nonsurgically treated infective endocarditis patients. Hellenic J Cardiol 2020; 61:246-252. [DOI: 10.1016/j.hjc.2019.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/03/2019] [Accepted: 01/11/2019] [Indexed: 11/25/2022] Open
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14
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Madonna R, Bonitatibus G, Vitulli P, Pierdomenico SD, Galiè N, De Caterina R. Association of the European Society of Cardiology echocardiographic probability grading for pulmonary hypertension with short and mid-term clinical outcomes after heart valve surgery. Vascul Pharmacol 2020; 125-126:106648. [PMID: 31904543 DOI: 10.1016/j.vph.2020.106648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/02/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Pulmonary hypertension (PH) is associated with higher mortality and morbidity after valvular heart surgery, mainly through its adverse effect on right ventricular hemodynamic. Recently, the European Society of Cardiology (ESC) PH guidelines introduced a PH probability grading that lists additional parameters related to right ventricular dimensions. We evaluated the impact of such score on short- and mid-term outcomes in patients undergoing left heart valvular surgery. METHODS AND RESULTS We included 60 consecutive patients (mean age 70 ± 9 years) undergoing left heart valvular surgery with or without coronary artery bypass. Patients were divided into 3 groups according to the PH probability: "low" (n = 18), "intermediate" (n = 18), or "high" (n = 24). The high PH probability group had higher rate of World Health Organization-Functional Class (WHO-FC) III and IV, hemodynamic complications, deaths, major bleeding events and infections after heart surgery than the other groups. A "high" PH probability was associated with reduced right ventricular systolic function, as measured by the fractional area change (FAC), but not with the tricuspid annular plane systolic excursion (TAPSE). CONCLUSION The high PH probability as evaluated by the ESC PH echocardiographic probability model, is associated with increased short- and mid-term mortality and morbidity and reduced right ventricular systolic function after cardiac surgery, Thus, additional echocardiographic parameters assessing PH probability are valuable tools to stratify risk in patients undergoing cardiac surgery.
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Affiliation(s)
| | | | | | | | - Nazzareno Galiè
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Bologna University Hospital, Bologna, Italy
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15
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Rojas SV, Trinh-Adams ML, Uribarri A, Fleissner F, Iablonskii P, Rojas-Hernandez S, Ricklefs M, Martens A, Rümke S, Warnecke G, Cebotari S, Haverich A, Ismail I. Early surgical myocardial revascularization in non-ST-segment elevation acute coronary syndrome. J Thorac Dis 2019; 11:4444-4452. [PMID: 31903232 PMCID: PMC6940209 DOI: 10.21037/jtd.2019.11.08] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 08/20/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND In non-ST-elevation myocardial infarction (NSTEMI) there is no consensus regarding optimal time point for coronary artery bypass grafting (CABG). Recent findings suggest that long-term outcomes are improved in early-revascularized NSTEMI patients. However, it has been stated that early surgery is associated to increased operative risk. In this study, we wanted to elucidate if early CABG in non-ST-elevation acute coronary syndrome can be performed safely. METHODS We performed a monocentric-prospective observational study within a 2-year interval. A total of 217 consecutive patients (41 female, age 68.9±10.2, ES II 6.62±8.56) developed NSTEMI and underwent CABG. Patients were divided into two groups according to the time point of coronary artery bypass after symptom onset (group A: <72 h; group B: >72 h). Endpoints included 6-month mortality and incidence of MACE (death, stroke or re-infarction). RESULTS There were no differences regarding mortality between both groups (30 days: group A 2.4% vs. group B 3.7%; P=0.592; 6 months: 8.4% vs. 6.0%; P=0.487). Incidence of MACE in the 6-month follow-up was also similar in both groups (group A: 9.6% vs. 9.7%, P=0.982). Regression analysis revealed as independent risk factors for mortality in the entire cohort ES II OR 1.045 (95% CI: 1.004-1.088). ES II remained an independent prognostic factor in group A OR 1.043 (95% CI: 1.003-1.086) and group B OR 1.032 (95% CI: 1.001-1.063). CONCLUSIONS Early revascularized patients showed a higher level of illness. However, results of early CABG were comparable to those following delayed revascularization. Moreover, EuroSCORE II was determined as independent risk factors for mortality.
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Affiliation(s)
- Sebastian V. Rojas
- Department of Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Mai Linh Trinh-Adams
- Department of Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Aitor Uribarri
- Department of Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Hannover, Germany
- Department of Cardiology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Felix Fleissner
- Department of Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Pavel Iablonskii
- Department of Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Sara Rojas-Hernandez
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Marcel Ricklefs
- Department of Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Andreas Martens
- Department of Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Stefan Rümke
- Department of Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Gregor Warnecke
- Department of Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Serghei Cebotari
- Department of Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Issam Ismail
- Department of Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Hannover, Germany
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16
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Gatti G, Sponga S, Peghin M, Givone F, Ferrara V, Benussi B, Mazzaro E, Perrotti A, Bassetti M, Luzzati R, Chocron S, Pappalardo A, Livi U. Risk scores and surgery for infective endocarditis: in search of a good predictive score. SCAND CARDIOVASC J 2019; 53:117-124. [PMID: 31007096 DOI: 10.1080/14017431.2019.1610188] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objectives: To evaluate scoring systems that have been created to predict the risk of death post-surgery in infective endocarditis (IE). Design: Eight scores - (1) The Society of Thoracic Surgery (STS) risk score for IE, (2) De Feo score, (3) PALSUSE score (prosthetic valve, age ≥70, large intracardiac destruction, Staphylococcus spp, urgent surgery, sex [female], EuroSCORE ≥10), (4) ANCLA score (anemia, New York Heart Association class IV, critical state, large intracardiac destruction, surgery of thoracic aorta), (5) Risk-Endocarditis Score (RISK-E), (6) score for heart valve or prosthesis IE (EndoSCORE), and (7,8) Association pour l'Étude et la Prévention de l'Endocadite Infectieuse (AEPEI) score I and II - were evaluated in 324 (mean age, 61.8 ± 14.6 years) consecutive patients having IE and undergoing cardiac operation (1999-2018, Regione Autonoma Friuli-Venezia Giulia, Italy). Results: There were 45 (13.9%) in-hospital deaths. Despite many differences on the number and the type of variables, all the investigated scores showed good goodness-of-fit (Hosmer-Lemeshow test, p ≥.28). For five scores, accuracy of prediction (receiver-operating characteristic curve analysis) was good (ANCLA score) or fair (STS risk score for IE, PALSUSE score, AEPEI score I and II). When compared one-to-one (Hanley-McNeil method), accuracy of prediction of ANCLA score was higher than all of other risk scores except for AEPEI score I (p = .077). Conclusions: Five of eight scores that were evaluated in this study showed satisfactory performance in predicting in-hospital mortality following surgery for IE. The ANCLA score should be preferred.
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Affiliation(s)
- Giuseppe Gatti
- a Cardio-Thoracic and Vascular Department , University Hospital of Trieste , Trieste , Italy
| | - Sandro Sponga
- b Department of Cardio-Thoracic Surgery , University Hospital of Udine , Udine , Italy
| | - Maddalena Peghin
- c Department of Infective Diseases , University Hospital of Udine , Udine , Italy
| | - Filippo Givone
- c Department of Infective Diseases , University Hospital of Udine , Udine , Italy
| | - Veronica Ferrara
- b Department of Cardio-Thoracic Surgery , University Hospital of Udine , Udine , Italy
| | - Bernardo Benussi
- a Cardio-Thoracic and Vascular Department , University Hospital of Trieste , Trieste , Italy
| | - Enzo Mazzaro
- b Department of Cardio-Thoracic Surgery , University Hospital of Udine , Udine , Italy
| | - Andrea Perrotti
- d Department of Thoracic and Cardiovascular Surgery , University Hospital Jean Minjoz , Besançon , France
| | - Matteo Bassetti
- c Department of Infective Diseases , University Hospital of Udine , Udine , Italy
| | - Roberto Luzzati
- e Department of Infective Diseases , University Hospital of Trieste , Trieste , Italy
| | - Sidney Chocron
- d Department of Thoracic and Cardiovascular Surgery , University Hospital Jean Minjoz , Besançon , France
| | - Aniello Pappalardo
- a Cardio-Thoracic and Vascular Department , University Hospital of Trieste , Trieste , Italy
| | - Ugolino Livi
- b Department of Cardio-Thoracic Surgery , University Hospital of Udine , Udine , Italy
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17
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Duchnowski P, Hryniewiecki T, Kuśmierczyk M, Szymanski P. Performance of the EuroSCORE II and the Society of Thoracic Surgeons score in patients undergoing aortic valve replacement for aortic stenosis. J Thorac Dis 2019; 11:2076-2081. [PMID: 31285901 DOI: 10.21037/jtd.2019.04.48] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background The aim of the study was to assess the predictive ability of risk calculators of the EuroSCORE II and the Society of Thoracic Surgeons (STS) score in patients undergoing aortic valve replacement (AVR) due to severe aortic valve stenosis (AS) during a 30-day and 1-year follow-up. Methods A prospective study was conducted on a group of consecutive patients with hemodynamically significant aortic valve stenosis that underwent elective valve replacement surgery. The risk of surgery using EuroSCORE II and STS was calculated for each patient. The primary and secondary endpoints were 30-day and 1-year mortality. Results The study group included 428 consecutive patients who underwent replacement of the aortic valve. Thirteen patients died during the 30-day follow-up and 25 patients died during 1-year follow-up. Actual mortality in 30-day observation was 3.0% compared to the predicted 2.9% using EuroSCORE II and 2.1% for STS. The discriminations of ES II and STS score were above 0.8 for mortality prediction during the 30-day and 1-year observation period. Conclusions The EuroSCORE II and STS score showed satisfactory discrimination and calibration for predicting 30-day and 1-year mortality in patients undergoing AVR.
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Affiliation(s)
- Piotr Duchnowski
- Institute of Cardiology, Department of Acquired Cardiac Defects, Warsaw, Poland
| | - Tomasz Hryniewiecki
- Institute of Cardiology, Department of Acquired Cardiac Defects, Warsaw, Poland
| | - Mariusz Kuśmierczyk
- Institute of Cardiology, Department of Cardiosurgery and Transplantology, Warsaw, Poland
| | - Piotr Szymanski
- Institute of Cardiology, Department of Acquired Cardiac Defects, Warsaw, Poland
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18
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El Hadj Sidi C, Mgarrech I, Tarmiz A, Jerbi S. External validation of the European System for Cardiac Operative Risk Evaluation II in a Tunisian population. J Card Surg 2019; 34:266-273. [PMID: 30873659 DOI: 10.1111/jocs.14015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 02/17/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The main objective of this study is to evaluate the performance of the predictive model (EuroSCORE II) on a Tunisian population to validate its use in our country. METHODS This is a retrospective study of data from 418 adult patients undergoing cardiac surgery with cardiopulmonary bypass between 1 January 2015 and 31 December 2016 in the department of cardiovascular and thoracic surgery of the Sahloul University Hospital of Sousse. The EuroSCORE ΙΙ is calculated using the application validated on the site www.euroscore.org. The performance of the score is evaluated by analyzing its discriminative power by constructing the receiver operating characteristic (ROC) curve and analyzing its calibration using the Hosmer-Lemeshow statistics. RESULTS The EuroSCORE II shows good discriminative power in our population with an area under the ROC curve more than 0.7 in all study groups (0.864 ± 0.032 for general cardiac surgery, 0.822 ± 0.061 for coronary surgery, 0.864 ± 0.052 for valvular surgery, and 0.900 ± 0.041 for urgent cardiac surgery). The model appears to be calibrated as well by obtaining P values above the statistical significance level of 0.05 (0.638 for general cardiac surgery, 0.543 for coronary surgery, 0.179 for valvular surgery, and 0.082 for urgent cardiac surgery). CONCLUSION The EuroSCORE II presents acceptable performance in our population, attested by a good discriminative power and an adequate calibration.
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Affiliation(s)
- Chighaly El Hadj Sidi
- Department of Cardiovascular and Thoracic Surgery, Sahloul University Hospital, Sousse, Tunisia
| | - Imen Mgarrech
- Department of Cardiovascular and Thoracic Surgery, Sahloul University Hospital, Sousse, Tunisia
| | - Amine Tarmiz
- Department of Cardiovascular and Thoracic Surgery, Sahloul University Hospital, Sousse, Tunisia
| | - Sofiane Jerbi
- Department of Cardiovascular and Thoracic Surgery, Sahloul University Hospital, Sousse, Tunisia
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19
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Chichareon P, Modolo R, van Klaveren D, Takahashi K, Kogame N, Chang CC, Katagiri Y, Tomaniak M, Asano T, Spitzer E, Buszman P, Prokopczuk J, Fath-Ordoubadi F, Buysschaert I, Anderson R, Oldroyd KG, Merkely B, Garg S, Wykrzykowska JJ, Piek JJ, Jüni P, Hamm C, Steg PG, Valgimigli M, Vranckx P, Windecker S, Onuma Y, Serruys PW. Predictive ability of ACEF and ACEF II score in patients undergoing percutaneous coronary intervention in the GLOBAL LEADERS study. Int J Cardiol 2019; 286:43-50. [PMID: 30846254 DOI: 10.1016/j.ijcard.2019.02.043] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/05/2019] [Accepted: 02/18/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND ACEF score has been shown to have predictive ability in the patients undergoing percutaneous coronary intervention (PCI). The ACEF II score has recently been developed to predict short-term mortality after cardiac surgery. We compared the predictive ability of the ACEF and ACEF II scores to predict mortality after PCI in the all-comers population. METHODS The ACEF and ACEF II scores were calculated in 15,968 patients enrolled in the GLOBAL LEADERS study. Discrimination and calibration were assessed for outcomes after PCI. Recalibration of the regression model by updating the intercept and slope were performed to adjust the original ACEF model to the PCI setting. In a stratified approach, patients were divided into quintiles according to the score. Outcomes were compared between quintiles. RESULTS The ACEF and ACEF II score were available in 14,941 and 14,355 patients respectively. Discrimination for 30-day all-cause mortality was acceptable for both scores (C-statistic ACEF 0.75 and ACEF II 0.77). For 2-year all-cause mortality, the discrimination of ACEF score was acceptable (C-statistic 0.72) while the discrimination of ACEF II score was moderate (C-statistic 0.69). Both scores identified patients at high risk of mortality but overestimated all-cause mortality at 30 days in all quintiles. After recalibration, agreement between predicted and observed 30-day all-cause mortality in both scores are close to the identity line. CONCLUSIONS The ACEF II model did not improve the predictive ability of the ACEF score. Recalibrated ACEF model can be used to estimated all-cause mortality rate at 30 days after PCI.
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Affiliation(s)
- Ply Chichareon
- Amsterdam UMC, University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands; Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Rodrigo Modolo
- Amsterdam UMC, University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands; Department of Internal Medicine, Cardiology Division, University of Campinas (UNICAMP), Campinas, Brazil
| | - David van Klaveren
- Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands
| | - Kuniaki Takahashi
- Amsterdam UMC, University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Norihiro Kogame
- Amsterdam UMC, University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Chun-Chin Chang
- Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands
| | - Yuki Katagiri
- Amsterdam UMC, University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Mariusz Tomaniak
- Department of Cardiology, Erasmus Medical Centre, Thorax Centre, Rotterdam, the Netherlands; First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Taku Asano
- Amsterdam UMC, University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Ernest Spitzer
- Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands; Cardialysis Clinical Trials Management and Core Laboratories, Westblaak 98, Rotterdam, the Netherlands
| | - Pawel Buszman
- Medical University of Silesia, Katowice, Poland; American Heart of Poland, Ustron, Poland
| | - Janusz Prokopczuk
- IV Department of Cardiology, American Heart of Poland, Kędzierzyn Koźle, Poland
| | - Farzin Fath-Ordoubadi
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester University Foundation Trusts, Oxford Rd, Manchester M13 9WL, United Kingdom
| | - Ian Buysschaert
- Department of Cardiology, ASZ Hospital Aalst, Merestraat 80, 9300 Aalst, Belgium
| | - Richard Anderson
- Cardiff and Vale University Health Board Heath Park, Cardiff, Wales, United Kingdom
| | - Keith G Oldroyd
- West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Scot Garg
- East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, United Kingdom
| | - Joanna J Wykrzykowska
- Amsterdam UMC, University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jan J Piek
- Amsterdam UMC, University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - Christian Hamm
- Kerckhoff Heart Center, Campus University of Giessen, Bad Nauheim, Germany
| | - Philippe Gabriel Steg
- FACT, French Alliance for Cardiovascular Trials, Hôpital Bichat, AP-HP, Université Paris-Diderot, INSERM U-1148, Paris, France; Royal Brompton Hospital, Imperial College, London, United Kingdom
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Yoshinobu Onuma
- Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands
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Duchnowski P, Hryniewiecki T, Kuśmierczyk M, Szymański P. The usefulness of selected biomarkers in patients with valve disease. Biomark Med 2018; 12:1341-1346. [PMID: 30520658 DOI: 10.2217/bmm-2018-0101] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
AIM The aim of the study was to investigate the prognostic value of selected biomarkers in patients undergoing valve surgery. MATERIALS & METHODS A prospective study was conducted on a group of consecutive patients with hemodynamically significant valve defects that underwent elective valve repair or replacement surgery. The primary end point was any major adverse event including death within 30 days. RESULTS The study group included 416 patients. The composite end point occurred in 81 patients. At multivariate analysis high-sensitivity C-reactive protein (p = 0.03), red cell distribution width (p = 0.0001) and red blood cell count (p = 0.005) remained independent predictors of the primary end point. CONCLUSION Elevated high-sensitivity C-reactive protein, red cell distribution width and red blood cell count were associated with a poorer outcome following valve surgery.
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Affiliation(s)
- Piotr Duchnowski
- Department of Acquired Cardiac Defects, Institute of Cardiology, Warsaw, Poland
| | - Tomasz Hryniewiecki
- Department of Acquired Cardiac Defects, Institute of Cardiology, Warsaw, Poland
| | - Mariusz Kuśmierczyk
- Department of Cardiosurgery & Transplantology, Institute of Cardiology, Warsaw, Poland
| | - Piotr Szymański
- Department of Acquired Cardiac Defects, Institute of Cardiology, Warsaw, Poland
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21
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Hogervorst EK, Rosseel PMJ, van de Watering LMG, Brand A, Bentala M, van der Meer BJM, van der Bom JG. Prospective validation of the EuroSCORE II risk model in a single Dutch cardiac surgery centre. Neth Heart J 2018; 26:540-551. [PMID: 30232783 PMCID: PMC6220016 DOI: 10.1007/s12471-018-1161-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objective The EuroSCORE I was one of the most frequently used pre-operative risk models in cardiac surgery. In 2011 it was replaced by its successor the EuroSCORE II. This study aims to validate the EuroSCORE II and to compare its performance with the EuroSCORE I in a Dutch hospital. Methods The EuroSCORE II was prospectively validated in 2,296 consecutive cardiac surgery patients between 1 April 2012 and 1 January 2014. Receiver operating characteristic curves on in-hospital mortality were plotted for EuroSCORE I and EuroSCORE II, and the area under the curve was calculated to assess discriminative power. Calibration was assessed by comparing observed versus expected mortality. Additionally, analyses were performed in which we stratified for type of surgery and for elective versus emergency surgery. Results The observed mortality was 2.4% (55 patients). The discriminative power of the EuroSCORE II surpassed that of the EuroSCORE I (area under the curve EuroSCORE II 0.871, 95% confidence interval (CI) 0.832–0.911; area under the curve additive EuroSCORE I 0.840, CI 0.798–0.882; area under the curve logistic EuroSCORE I 0.761, CI 0.695–0.828). Both the additive and the logistic EuroSCORE I overestimated mortality (predictive mortality additive EuroSCORE I median 5.0%, inter-quartile range 3.0–8.0%; logistic EuroSCORE I 10.7%, inter-quartile range 5.8–13.9), while the EuroSCORE II underestimated mortality (median 1.6%, inter-quartile range 1.0–3.5). In most stratified analyses the EuroSCORE II performed better. Conclusion Our results show that the EuroSCORE II produces a valid risk prediction and outperforms the EuroSCORE I in elective cardiac surgery patients.
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Affiliation(s)
- E K Hogervorst
- Centre for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands. .,Jon J van Rood Centre for Clinical Transfusion Research, Leiden University Medical Centre, Leiden, The Netherlands. .,Department of Anaesthesiology, University of Groningen, Groningen, The Netherlands. .,University Medical Centre Groningen, Groningen, The Netherlands.
| | - P M J Rosseel
- Department of Anaesthesia and Intensive Care, Amphia Hospital, Breda, The Netherlands
| | - L M G van de Watering
- Centre for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Jon J van Rood Centre for Clinical Transfusion Research, Leiden University Medical Centre, Leiden, The Netherlands
| | - A Brand
- Centre for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Jon J van Rood Centre for Clinical Transfusion Research, Leiden University Medical Centre, Leiden, The Netherlands
| | - M Bentala
- Department of Anaesthesia and Intensive Care, Amphia Hospital, Breda, The Netherlands
| | - B J M van der Meer
- Department of Anaesthesia and Intensive Care, Amphia Hospital, Breda, The Netherlands.,TIAS, Tilburg University, Tilburg, The Netherlands
| | - J G van der Bom
- Centre for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Jon J van Rood Centre for Clinical Transfusion Research, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
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22
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Grant SW, Collins GS, Nashef SAM. Statistical Primer: developing and validating a risk prediction model†. Eur J Cardiothorac Surg 2018; 54:203-208. [DOI: 10.1093/ejcts/ezy180] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 04/02/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Stuart W Grant
- Department of Academic Surgery, University of Manchester, Manchester, UK
| | - Gary S Collins
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Samer A M Nashef
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
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Fernández-Hidalgo N, Ferreria-González I, Marsal JR, Ribera A, Aznar ML, de Alarcón A, García-Cabrera E, Gálvez-Acebal J, Sánchez-Espín G, Reguera-Iglesias JM, De La Torre-Lima J, Lomas JM, Hidalgo-Tenorio C, Vallejo N, Miranda B, Santos-Ortega A, Castro MA, Tornos P, García-Dorado D, Almirante B. A pragmatic approach for mortality prediction after surgery in infective endocarditis: optimizing and refining EuroSCORE. Clin Microbiol Infect 2018; 24:1102.e7-1102.e15. [PMID: 29408350 DOI: 10.1016/j.cmi.2018.01.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/13/2018] [Accepted: 01/20/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To simplify and optimize the ability of EuroSCORE I and II to predict early mortality after surgery for infective endocarditis (IE). METHODS Multicentre retrospective study (n = 775). Simplified scores, eliminating irrelevant variables, and new specific scores, adding specific IE variables, were created. The performance of the original, recalibrated and specific EuroSCOREs was assessed by Brier score, C-statistic and calibration plot in bootstrap samples. The Net Reclassification Index was quantified. RESULTS Recalibrated scores including age, previous cardiac surgery, critical preoperative state, New York Heart Association >I, and emergent surgery (EuroSCORE I and II); renal failure and pulmonary hypertension (EuroSCORE I); and urgent surgery (EuroSCORE II) performed better than the original EuroSCOREs (Brier original and recalibrated: EuroSCORE I: 0.1770 and 0.1667; EuroSCORE II: 0.2307 and 0.1680). Performance improved with the addition of fistula, staphylococci and mitral location (EuroSCORE I and II) (Brier specific: EuroSCORE I 0.1587, EuroSCORE II 0.1592). Discrimination improved in specific models (C-statistic original, recalibrated and specific: EuroSCORE I: 0.7340, 0.7471 and 0.7728; EuroSCORE II: 0.7442, 0.7423 and 0.7700). Calibration improved in both EuroSCORE I models (intercept 0.295, slope 0.829 (original); intercept -0.094, slope 0.888 (recalibrated); intercept -0.059, slope 0.925 (specific)) but only in specific EuroSCORE II model (intercept 2.554, slope 1.114 (original); intercept -0.260, slope 0.703 (recalibrated); intercept -0.053, slope 0.930 (specific)). Net Reclassification Index was 5.1% and 20.3% for the specific EuroSCORE I and II. CONCLUSIONS The use of simplified EuroSCORE I and EuroSCORE II models in IE with the addition of specific variables may lead to simpler and more accurate models.
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Affiliation(s)
- N Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
| | - I Ferreria-González
- Unitat d'Epidemiologia, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
| | - J R Marsal
- Unitat d'Epidemiologia, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Unitat de Suport a la Recerca Lleida-Pirineus, IDIAP Jordi Gol, Lleida, Spain
| | - A Ribera
- Unitat d'Epidemiologia, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - M L Aznar
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A de Alarcón
- Universitat Autònoma de Barcelona, Barcelona, Spain; Unidad Clínica de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain; Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas, Spain
| | - E García-Cabrera
- Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas, Spain
| | - J Gálvez-Acebal
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas, Spain; Unidad Clínica de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
| | - G Sánchez-Espín
- Unidad de Gestión Clínica del Corazón, Instituto de Investigación Biomédica de Málaga (BIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - J M Reguera-Iglesias
- Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas, Spain; Servicio de Enfermedades Infecciosas, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - J De La Torre-Lima
- Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas, Spain; Grupo de Enfermedades Infecciosas de la Unidad de Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - J M Lomas
- Unitat de Suport a la Recerca Lleida-Pirineus, IDIAP Jordi Gol, Lleida, Spain; Unidad de Enfermedades Infecciosas, Hospitales Juan Ramón Jiménez-Infanta Elena, Huelva, Spain
| | - C Hidalgo-Tenorio
- Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas, Spain; Servicio de Medicina Interna, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - N Vallejo
- Servicio de Cardiología, Grupo de Trabajo de Endocarditis Infecciosa, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - B Miranda
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - A Santos-Ortega
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M A Castro
- Servei de Cirurgia Cardíaca, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - P Tornos
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - D García-Dorado
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - B Almirante
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
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A predictive model for early mortality after surgical treatment of heart valve or prosthesis infective endocarditis. The EndoSCORE. Int J Cardiol 2017; 241:97-102. [DOI: 10.1016/j.ijcard.2017.03.148] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 03/28/2017] [Indexed: 11/22/2022]
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Gatti G, Perrotti A, Obadia JF, Duval X, Iung B, Alla F, Chirouze C, Selton-Suty C, Hoen B, Sinagra G, Delahaye F, Tattevin P, Le Moing V, Pappalardo A, Chocron S. Simple Scoring System to Predict In-Hospital Mortality After Surgery for Infective Endocarditis. J Am Heart Assoc 2017; 6:JAHA.116.004806. [PMID: 28729412 PMCID: PMC5586260 DOI: 10.1161/jaha.116.004806] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Aspecific scoring systems are used to predict the risk of death postsurgery in patients with infective endocarditis (IE). The purpose of the present study was both to analyze the risk factors for in‐hospital death, which complicates surgery for IE, and to create a mortality risk score based on the results of this analysis. Methods and Results Outcomes of 361 consecutive patients (mean age, 59.1±15.4 years) who had undergone surgery for IE in 8 European centers of cardiac surgery were recorded prospectively, and a risk factor analysis (multivariable logistic regression) for in‐hospital death was performed. The discriminatory power of a new predictive scoring system was assessed with the receiver operating characteristic curve analysis. Score validation procedures were carried out. Fifty‐six (15.5%) patients died postsurgery. BMI >27 kg/m2 (odds ratio [OR], 1.79; P=0.049), estimated glomerular filtration rate <50 mL/min (OR, 3.52; P<0.0001), New York Heart Association class IV (OR, 2.11; P=0.024), systolic pulmonary artery pressure >55 mm Hg (OR, 1.78; P=0.032), and critical state (OR, 2.37; P=0.017) were independent predictors of in‐hospital death. A scoring system was devised to predict in‐hospital death postsurgery for IE (area under the receiver operating characteristic curve, 0.780; 95% CI, 0.734–0.822). The score performed better than 5 of 6 scoring systems for in‐hospital death after cardiac surgery that were considered. Conclusions A simple scoring system based on risk factors for in‐hospital death was specifically created to predict mortality risk postsurgery in patients with IE.
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Affiliation(s)
- Giuseppe Gatti
- Cardiovascular Department, University Hospital of Trieste, Italy
| | - Andrea Perrotti
- Department of Thoracic and Cardiovascular Surgery, EA3920, University Hospital Jean Minjoz, Besançon, France
| | | | - Xavier Duval
- IAME, Inserm UMR 1137, University Paris Diderot Sorbonne Paris Cité, Paris, France.,Inserm Clinical Investigation Center 1425, Paris, France
| | - Bernard Iung
- Department of Cardiology, AP-HP, Bichat Hospital, Paris, France.,DHU Fire, Paris, France
| | | | - Catherine Chirouze
- Department of Infective and Tropical Diseases, University Hospital Jean Minjoz, Besançon, France
| | | | - Bruno Hoen
- Department of Infective and Tropical Diseases, University Hospital of Pointe à Pitre, France
| | | | | | - Pierre Tattevin
- Department of Infective and Tropical Diseases, University Regional Hospital, Rennes, France
| | - Vincent Le Moing
- Department of Infective and Tropical Diseases, University Regional Hospital, Rennes, France.,UMI 233, Institute of Development Research, University of Montpellier, France
| | | | - Sidney Chocron
- Department of Thoracic and Cardiovascular Surgery, EA3920, University Hospital Jean Minjoz, Besançon, France
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Mateos-Pañero B, Sánchez-Casado M, Castaño-Moreira B, Paredes-Astillero I, López-Almodóvar LF, Bustos-Molina F. Assessment of Euroscore and SAPS III as hospital mortality predicted in cardiac surgery. ACTA ACUST UNITED AC 2017; 64:273-281. [PMID: 28258745 DOI: 10.1016/j.redar.2016.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 11/20/2016] [Accepted: 11/22/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To perform an external validation of Euroscore I, Euroscore II and SAPS III. PATIENTS AND METHOD Retrospective cohort study over three years on all adult patients who underwent cardiac surgery. We reviewed the clinical data, following the patient until outcome or discharge from hospital (dead, alive). We computed the predicted mortality by Euroscore I (EI), II (EII) and SAPS III. The model validation was assessed by discrimination: area under curve ROC; and calibration (Hosmer-Lemeshow test). RESULTS 866 patients were included. 62.5% of them male, with a median age of 69 years, 6.1% died during hospitalization. Predicted mortality: E I 7.94%, E II 3.54, SAPS III 12.1%. Area under curve (95% IC): E I 0.862 (0.812-0.912); E II 0.861 (0.806-0.915); SAPS III 0.692 (0.601-0.784). Hosmer-Lemeshow test: E I 14.0046 (P=.08164); E II 33.67 (P=.00004660); SAPS III 11.57 (P=.171). CONCLUSIONS EII had good discrimination, but the calibration was not good with predicted mortality lower than the real mortality. E I showed the best discrimination with good calibration and a tendency to overestimate the mortality. SAPS III showed poor discrimination with good calibration and a tendency to greatly overestimate the predicted mortality. We saw no improvement in the predictive performance of EII over I and we reject the use of SAPS III in this kind of patient.
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Affiliation(s)
- B Mateos-Pañero
- Unidad de Críticos Cirugía Cardiaca, Servicio de Anestesia, Hospital Virgen de la Salud, Toledo, España
| | - M Sánchez-Casado
- Unidad de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, España.
| | - B Castaño-Moreira
- Unidad de Críticos Cirugía Cardiaca, Servicio de Anestesia, Hospital Virgen de la Salud, Toledo, España
| | - I Paredes-Astillero
- Unidad de Críticos Cirugía Cardiaca, Servicio de Anestesia, Hospital Virgen de la Salud, Toledo, España
| | | | - F Bustos-Molina
- Unidad de Críticos Cirugía Cardiaca, Servicio de Anestesia, Hospital Virgen de la Salud, Toledo, España
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Gatti G, Benussi B, Gripshi F, Della Mattia A, Proclemer A, Cannatà A, Dreas L, Luzzati R, Sinagra G, Pappalardo A. A risk factor analysis for in-hospital mortality after surgery for infective endocarditis and a proposal of a new predictive scoring system. Infection 2017; 45:413-423. [DOI: 10.1007/s15010-016-0977-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 12/21/2016] [Indexed: 11/30/2022]
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Jenkins DP, Cooper G. Publicly Available Outcome Data for Individual Surgeons: Lessons from Cardiac Surgery. Eur Urol 2016; 71:309-310. [PMID: 27707510 DOI: 10.1016/j.eururo.2016.09.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 09/12/2016] [Indexed: 11/28/2022]
Abstract
Surgeon-specific outcome data for cardiac surgery have been published in the UK since 2005 and have been associated with improvement in risk-adjusted survival over time. This reassurance about the safety of cardiac surgery is unique in the world, but it remains controversial.
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Affiliation(s)
- David P Jenkins
- Society for Cardiothoracic Surgery, Royal College of Surgeons of England, London, UK.
| | - Graham Cooper
- Society for Cardiothoracic Surgery, Royal College of Surgeons of England, London, UK
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Hickey GL, Blackstone EH. External model validation of binary clinical risk prediction models in cardiovascular and thoracic surgery. J Thorac Cardiovasc Surg 2016; 152:351-5. [DOI: 10.1016/j.jtcvs.2016.04.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 03/22/2016] [Accepted: 04/02/2016] [Indexed: 12/23/2022]
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Bashir M, Shaw MA, Grayson AD, Fok M, Hickey GL, Grant SW, Bridgewater B, Oo AY. Development and Validation of Elective and Nonelective Risk Prediction Models for In-Hospital Mortality in Proximal Aortic Surgery Using the National Institute for Cardiovascular Outcomes Research (NICOR) Database. Ann Thorac Surg 2016; 101:1670-6. [DOI: 10.1016/j.athoracsur.2015.10.067] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 08/30/2015] [Accepted: 10/09/2015] [Indexed: 10/22/2022]
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A contemporary risk model for predicting 30-day mortality following percutaneous coronary intervention in England and Wales. Int J Cardiol 2016; 210:125-32. [PMID: 26942330 PMCID: PMC4819905 DOI: 10.1016/j.ijcard.2016.02.085] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 02/08/2016] [Accepted: 02/14/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND The current risk model for percutaneous coronary intervention (PCI) in the UK is based on outcomes of patients treated in a different era of interventional cardiology. This study aimed to create a new model, based on a contemporary cohort of PCI treated patients, which would: predict 30 day mortality; provide good discrimination; and be well calibrated across a broad risk-spectrum. METHODS AND RESULTS The model was derived from a training dataset of 336,433 PCI cases carried out between 2007 and 2011 in England and Wales, with 30 day mortality provided by record linkage. Candidate variables were selected on the basis of clinical consensus and data quality. Procedures in 2012 were used to perform temporal validation of the model. The strongest predictors of 30-day mortality were: cardiogenic shock; dialysis; and the indication for PCI and the degree of urgency with which it was performed. The model had an area under the receiver operator characteristic curve of 0.85 on the training data and 0.86 on validation. Calibration plots indicated a good model fit on development which was maintained on validation. CONCLUSION We have created a contemporary model for PCI that encompasses a range of clinical risk, from stable elective PCI to emergency primary PCI and cardiogenic shock. The model is easy to apply and based on data reported in national registries. It has a high degree of discrimination and is well calibrated across the risk spectrum. The examination of key outcomes in PCI audit can be improved with this risk-adjusted model.
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Ainsworth J, Buchan I. Combining Health Data Uses to Ignite Health System Learning. Methods Inf Med 2015; 54:479-87. [PMID: 26395036 DOI: 10.3414/me15-01-0064] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 06/09/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES In this paper we aim to characterise the critical mass of linked data, methods and expertise required for health systems to adapt to the needs of the populations they serve - more recently known as learning health systems. The objectives are to: 1) identify opportunities to combine separate uses of common data sources in order to reduce duplication of data processing and improve information quality; 2) identify challenges in scaling-up the reuse of health data sufficiently to support health system learning. METHODS The challenges and opportunities were identified through a series of e-health stakeholder consultations and workshops in Northern England from 2011 to 2014. From 2013 the concepts presented here have been refined through feedback to collaborators, including patient/citizen representatives, in a regional health informatics research network (www.herc.ac.uk). RESULTS Health systems typically have separate information pipelines for: 1) commissioning services; 2) auditing service performance; 3) managing finances; 4) monitoring public health; and 5) research. These pipelines share common data sources but usually duplicate data extraction, aggregation, cleaning/preparation and analytics. Suboptimal analyses may be performed due to a lack of expertise, which may exist elsewhere in the health system but is fully committed to a different pipeline. Contextual knowledge that is essential for proper data analysis and interpretation may be needed in one pipeline but accessible only in another. The lack of capable health and care intelligence systems for populations can be attributed to a legacy of three flawed assumptions: 1) universality: the generalizability of evidence across populations; 2) time-invariance: the stability of evidence over time; and 3) reducibility: the reduction of evidence into specialised sub-systems that may be recombined. CONCLUSIONS We conceptualize a population health and care intelligence system capable of supporting health system learning and we put forward a set of maturity tests of progress toward such a system. A factor common to each test is data-action latency; a mature system spawns timely actions proportionate to the information that can be derived from the data, and in doing so creates meaningful measurement about system learning. We illustrate, using future scenarios, some major opportunities to improve health systems by exchanging conventional intelligence pipelines for networked critical masses of data, methods and expertise that minimise data-action latency and ignite system-learning.
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Affiliation(s)
- J Ainsworth
- John Ainsworth, Centre for Health Informatics, University of Manchester, Manchester, M13 9PL, UK, E-mail:
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Patrat-Delon S, Rouxel A, Gacouin A, Revest M, Flécher E, Fouquet O, Le Tulzo Y, Lerolle N, Tattevin P, Tadié JM. EuroSCORE II underestimates mortality after cardiac surgery for infective endocarditis. Eur J Cardiothorac Surg 2015; 49:944-51. [DOI: 10.1093/ejcts/ezv223] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 05/27/2015] [Indexed: 11/13/2022] Open
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Affiliation(s)
- Ben Bridgewater
- University Hospital of South Manchester NHS Foundation Trust
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35
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Performance of the European System for Cardiac Operative Risk Evaluation II: A meta-analysis of 22 studies involving 145,592 cardiac surgery procedures. J Thorac Cardiovasc Surg 2014; 148:3049-57.e1. [DOI: 10.1016/j.jtcvs.2014.07.039] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 06/06/2014] [Accepted: 07/06/2014] [Indexed: 11/30/2022]
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36
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Koszta G, Sira G, Szatmári K, Farkas E, Szerafin T, Fülesdi B. Performance of EuroSCORE II in Hungary: A Single-centre Validation Study. Heart Lung Circ 2014; 23:1041-50. [DOI: 10.1016/j.hlc.2014.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 03/12/2014] [Accepted: 04/04/2014] [Indexed: 10/25/2022]
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Hickey GL, Grant SW, Freemantle N, Cunningham D, Munsch CM, Livesey SA, Roxburgh J, Buchan I, Bridgewater B. Surgeon length of service and risk-adjusted outcomes: linked observational analysis of the UK National Adult Cardiac Surgery Audit Registry and General Medical Council Register. J R Soc Med 2014; 107:355-64. [PMID: 25193057 DOI: 10.1177/0141076814538788] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To explore the relationship between in-hospital mortality following adult cardiac surgery and the time since primary clinical qualification for the responsible consultant cardiac surgeon (a proxy for experience). DESIGN Retrospective analysis of prospectively collected national registry data over a 10-year period using mixed-effects multiple logistic regression modelling. Surgeon experience was defined as the time between the date of surgery and award of primary clinical qualification. SETTING UK National Health Service hospitals performing cardiac surgery between January 2003 and December 2012. PARTICIPANTS All patients undergoing coronary artery bypass grafts and/or valve surgery under the care of a consultant cardiac surgeon. MAIN OUTCOME MEASURES All-cause in-hospital mortality. RESULTS A total of 292,973 operations performed by 273 consultant surgeons (with lengths of service from 11.2 to 42.0 years) were included. Crude mortality increased approximately linearly until 33 years service, before decreasing. After adjusting for case-mix and year of surgery, there remained a statistically significant (p=0.002) association between length of service and in-hospital mortality (odds ratio 1.013; 95% CI 1.005-1.021 for each year of 'experience'). CONCLUSIONS Consultant cardiac surgeons take on increasingly complex surgery as they gain experience. With this progression, the incidence of adverse outcomes is expected to increase, as is demonstrated in this study. After adjusting for case-mix using the EuroSCORE, we observed an increased risk of mortality in patients operated on by longer serving surgeons. This finding may reflect under-adjustment for risk, unmeasured confounding or a real association. Further research into outcomes over the time course of surgeon's careers is required.
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Affiliation(s)
- Graeme L Hickey
- Centre for Health Informatics, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PL, UK National Institute for Cardiovascular Outcomes Research (NICOR), University College London, London W1T 7HA, UK
| | - Stuart W Grant
- National Institute for Cardiovascular Outcomes Research (NICOR), University College London, London W1T 7HA, UK Department of Cardiothoracic Surgery, Manchester Academic Health Science Centre, University of Manchester, University Hospital of South Manchester, Manchester M23 9LT, UK
| | - Nick Freemantle
- Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | - David Cunningham
- National Institute for Cardiovascular Outcomes Research (NICOR), University College London, London W1T 7HA, UK
| | - Christopher M Munsch
- Department of Cardiothoracic Surgery, Leeds General Infirmary, Leeds LS1 3EX, UK
| | - Steven A Livesey
- Department of Cardiac Surgery, University Hospital Southampton, Southampton SO16 6YD, UK
| | - James Roxburgh
- Department of Cardiothoracic Surgery, St Thomas' Hospital, London SE1 7EH, UK
| | - Iain Buchan
- Centre for Health Informatics, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PL, UK
| | - Ben Bridgewater
- Centre for Health Informatics, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PL, UK National Institute for Cardiovascular Outcomes Research (NICOR), University College London, London W1T 7HA, UK Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
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Li CN, Chen L, Ge YP, Zhu JM, Liu YM, Zheng J, Liu W, Ma WG, Sun LZ. Risk Factors for Prolonged Mechanical Ventilation After Total Aortic Arch Replacement for Acute DeBakey Type I Aortic Dissection. Heart Lung Circ 2014; 23:869-74. [DOI: 10.1016/j.hlc.2014.03.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 03/03/2014] [Accepted: 03/13/2014] [Indexed: 11/26/2022]
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Select articles published on the topic of cardiovascular surgery in 2013. Circulation 2014; 129:e401-6. [PMID: 24664221 DOI: 10.1161/circulationaha.114.009715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Paparella D, Guida P, Di Eusanio G, Caparrotti S, Gregorini R, Cassese M, Fanelli V, Speziale G, Mazzei V, Zaccaria S, Schinosa LDLT, Fiore T. Risk stratification for in-hospital mortality after cardiac surgery: external validation of EuroSCORE II in a prospective regional registry. Eur J Cardiothorac Surg 2014; 46:840-8. [PMID: 24482382 DOI: 10.1093/ejcts/ezt657] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To evaluate performance of the European System for Cardiac Operation Risk Evaluation (EuroSCORE II), to assess the influence of model updating and to derive a hierarchical tree for modelling the relationship between EuroSCORE II risk factors and hospital mortality after cardiac surgery in a large prospective contemporary cohort of consecutive adult patients. METHODS Data on consecutive patients, who underwent on-pump cardiac surgery or off-pump coronary artery bypass graft intervention, were retrieved from Puglia Adult Cardiac Surgery Registry. Discrimination, calibration, re-estimation of EuroSCORE II coefficients and hierarchical tree analysis of risk factors were assessed. RESULTS Out 6293 procedures, 6191 (98.4%) had complete data for EuroSCORE II assessment with a hospital mortality rate of 4.85% and EuroSCORE II of 4.40 ± 7.04%. The area under the receiver operator characteristic curve (0.830) showed good discriminative ability of EuroSCORE II in distinguishing patients who died and those who survived. Calibration of EuroSCORE II was preserved with lower predicted than observed risk in the highest EuroSCORE II deciles. At logistic regression analysis, the complete revision of the model had most of re-estimated regression coefficients not statistically different from those in the original EuroSCORE II model. When missing values were replaced with the mean EuroSCORE II value according to urgency and weight of intervention, the risk score confirmed discrimination and calibration obtained over the entire sample. A recursive tree-building algorithm of EuroSCORE II variables identified three large groups (55.1, 17.1 and 18.1% of procedures) with low-to-moderate risk (observed mortality of 1.5, 3.2 and 6.4%) and two groups (3.8 and 5.9% of procedures) at high risk (mortality of 14.6 and 32.2%). Patients with low-to-moderate risk had good agreement between observed events and predicted frequencies by EuroSCORE II, whereas those at greater risk showed an underestimation of expected mortality. CONCLUSIONS This study demonstrates that EuroSCORE II is a good predictor of hospital mortality after cardiac surgery in an external validation cohort of contemporary patients from a multicentre prospective regional registry. The EuroSCORE II predicts hospital mortality with a slight underestimation in high-risk patients that should be further and better evaluated. The EuroSCORE II variables as a risk tree provides clinicians and surgeons a practical bedside tool for mortality risk stratification of patients at low, intermediate and high risk for hospital mortality after cardiac surgery.
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Affiliation(s)
- Domenico Paparella
- Division of Cardiac Surgery, Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy
| | | | | | | | - Renato Gregorini
- Department of Cardiac Surgery, Città di Lecce Hospital, Lecce, Italy
| | - Mauro Cassese
- Department of Cardiac Surgery, Santa Maria Hospital, Bari, Italy
| | | | | | - Valerio Mazzei
- Department of Cardiac Surgery, Villa Bianca Hospital, Bari, Italy
| | | | | | - Tommaso Fiore
- Division of Anesthesia, Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy
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Hickey GL, Cosgriff R, Grant SW, Cooper G, Deanfield J, Roxburgh J, Bridgewater B. A technical review of the United Kingdom National Adult Cardiac Surgery Governance Analysis 2008–11. Eur J Cardiothorac Surg 2013; 45:225-33. [DOI: 10.1093/ejcts/ezt476] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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