Mortality risk prediction in high-risk patients undergoing coronary artery bypass grafting: Are traditional risk scores accurate?

• Published in: PloS one Vol. 16; no. 8; p. e0255662
• Main Authors: Goncharov, Maxim, Mejia, Omar Asdrúbal Vilca, Arthur, Camila Perez de Souza, Orlandi, Bianca Maria Maglia, Sousa, Alexandre, Oliveira, Marco Antônio Praça, Atik, Fernando Antibas, Segalote, Rodrigo Coelho, Tiveron, Marcos Gradim, de Barros E Silva, Pedro Gabriel Melo, Nakazone, Marcelo Arruda, Lisboa, Luiz Augusto Ferreira, Dallan, Luís Alberto Oliveira, Zheng, Zhe, Hu, Shengshou, Jatene, Fabio Biscegli
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 03.08.2021; Public Library of Science (PLoS)
• Subjects: Aged; Angina; Area Under Curve; Biology and Life Sciences; Brazil - epidemiology; Calibration; Cardiac patients; Cardiovascular diseases; Care and treatment; China - epidemiology; Complications and side effects; Coronary artery; Coronary artery bypass; Coronary Artery Bypass - adverse effects; Coronary Artery Disease - epidemiology; Coronary Artery Disease - mortality; Coronary Artery Disease - surgery; Cross-Sectional Studies; Databases, Factual; Female; Health risks; Heart attacks; Heart surgery; Hospital Mortality; Humans; Male; Medicine and Health Sciences; Middle Aged; Model accuracy; Models, Statistical; Mortality; Patient outcomes; Patients; Performance evaluation; Prognosis; Prospective Studies; Risk; Risk Assessment; Risk Factors; Risk groups; ROC Curve; Treatment Outcome; Variables; Brazil; China; Beijing China; Rio de Janeiro Brazil
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0255662

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. 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. 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). 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.