Three Risk Scores For Mortality Prediction In Minimally Invasive Cardiac Surgery: Performance And Comparison
Rafik Margaryan, MD, PhD, Egidio Varone, MD, Giovanni Concistre', MD, Tommaso Gasbarri, MD, PhD, Giacomo Bianchi, MD, PhD, Pierandrea Farneti, MD, Enkel Kallushi, MD, Marco Solinas, MD.
Ospedale Del Cuore Fondazione 'G. Monasterio', Massa, Italy.
OBJECTIVE: Prediction of operative risk in adults undergoing minimally invasive cardiac surgery (MICS) remains a challenge. The European System for Cardiac Operation Risk Evaluation II (EuroSCORE II) and The Society of Thoracic Surgeons score are most commonly used in clinical settings but are not calibrated for MICS. Alternative risk scoring system is with its simplicity provide by ACEF score.
METHODS: We sought to test discrimination power and calibration of the above mentioned scores. We have identified patients who underwent MICS from 2007 to 2016 from prospective cardiac surgical database in a single institution. Additional variables were included if necessary for STS score, EuroSCORE II and ACEF score calculation.
RESULTS: A total of 2747 patients were identified from main database. There were actual 27 (1.4%) hospitals deaths. The mean STS score predicted mortality were 1.2 ± 1.1 %. Discriminatory power was uniformly good (for STS Mortality: AUC was 0.87; 95% confidence interval, 0.81 - 0.93). The mean EuroSCORE II predicted mortality were 2.4 ± 3.4 %. Discriminatory power was good but inferior to that of STS (for EuroSCORE II Mortality: AUC was 0.84; 95% confidence interval, 0.77 - 0.92). The mean ACEF predicted mortality were 2.4 ± 2.3 %. Discriminatory power was good but inferior to that of STS and ESII (for ACEF Mortality: AUC 0.72; 95% confidence interval, 0.63 - 0.82). STS score was underestimating mortality(p < 0.01), EuroSCORE II and ACEF were overestimating mortality (respectively, p < 0.01 and p < 0.01, see Figure 1).
CONCLUSIONS: The STS score and EuroSCORE II have very good discrimination power for MICS subset of patients. However, they are not calibrated for the same subset. ACEF score, very simple to calculate, performs with decent discrimination power but not calibrated for the MICS subset of patients. No algorithm seems well calibrated for accurate risk estimation.
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