Nadia Bouabdallaoui1, Susanna R Stevens2, Torsten Doenst3, Mark C Petrie4,5, Nawwar Al-Attar5, Imtiaz S Ali6, Andrew P Ambrosy7, Anna K Barton5, Raymond Cartier8, Alexander Cherniavsky9, Pierre Demondion10, Patrice Desvigne-Nickens11, Robert R Favaloro12, Sinisa Gradinac13, Petra Heinisch3, Anil Jain14, Marek Jasinski15, Jerome Jouan16, Renato A K Kalil17, Lorenzo Menicanti18, Robert E Michler19, Vivek Rao20, Peter K Smith21, Marian Zembala22, Eric J Velazquez7, Hussein R Al-Khalidi23, Jean L Rouleau1. 1. Departments of Medicine, ontreal Heart Institute, University of Montreal, Canada (N.B., J.L.R.). 2. M. Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. (S.R.S.). 3. Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, Germany (T.D., P.H.). 4. Department of Cardiology, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (M.C.P.). 5. Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (M.C.P., N.A.-A, A.K.B.). 6. Section of Cardiac Surgery, Department of Cardiac Sciences, Libin CV Institute, University of Calgary, Canada (I.S.A.). 7. Department of Medicine, Duke University School of Medicine, Durham, NC. (A.P.A., E.J.V.). 8. Cardiac Surgery, ontreal Heart Institute, University of Montreal, Canada (R.C.). 9. Research Institute of Circulation Pathology, Novosibirsk, Russia (A.C.). 10. Department of Cardiac Surgery, La Pitié Salpêtrière, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie-Paris 6, France (P.D.). 11. National Heart, Lung, and Blood Institute, Bethesda, MD (P.D.-N.). 12. Department of Cardiac Surgery, University Hospital Favaloro Foundation, Buenos Aires, Argentina (R.R.F.). 13. Dedinje Cardiovascular Institute, University of Belgrade School of Medicine, Serbia (S.G.). 14. Department of Cardiac Surgery, SAL Hospital and Medical Institute, Ahmedabad, India (A.J.). 15. Department of Cardiac Surgery, Wroclaw Medical University, Poland (M.J.). 16. Department of Cardiovascular Surgery, Georges Pompidou European Hospital and University Paris-Descartes, Sorbonne Paris-Cité, France (J.J.). 17. Postgraduate Program, Instituto de Cardiologia/FUC and UFCSPA, Porto Alegre, Brazil (R.A.K.K.). 18. Department of Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (L.M.). 19. Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York City, NY (R.E.M.). 20. Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Institute, University Health Network, University of Toronto, Canada (V.R.). 21. Department of Surgery, Duke University School of Medicine, Durham, NC. (P.K.S.). 22. Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases in Zabrze, Poland Medical University of Silesia in Katowice, Poland (M.Z.). 23. Departments of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC. (H.R.A.-K.).
Abstract
BACKGROUND: The STICH trial (Surgical Treatment for Ischemic Heart Failure) demonstrated a survival benefit of coronary artery bypass grafting in patients with ischemic cardiomyopathy and left ventricular dysfunction. The Society of Thoracic Surgeons (STS) risk score and the EuroSCORE-2 (ES2) are used for risk assessment in cardiac surgery, with little information available about their accuracy in patients with left ventricular dysfunction. We assessed the ability of the STS score and ES2 to evaluate 30-day postoperative mortality risk in STICH and a contemporary cohort (CC) of patients with a left ventricle ejection fraction ≤35% undergoing coronary artery bypass grafting outside of a trial setting. METHODS AND RESULTS: The STS and ES2 scores were calculated for 814 STICH patients and 1246 consecutive patients in a CC. There were marked variations in 30-day postoperative mortality risk from 1 patient to another. The STS scores consistently calculated lower risk scores than ES2 (1.5 versus 2.9 for the CC and 0.9 versus 2.4 for the STICH cohort), and underestimated postoperative mortality risk. The STS and ES2 scores had moderately good C statistics: CC (0.727, 95% CI: 0.650-0.803 for STS, and 0.707, 95% CI: 0.620-0.795 for ES2); STICH (0.744, 95% CI: 0.677-0.812, for STS and 0.736, 95% CI: 0.665-0.808 for ES2). Despite the CC patients having higher STS and ES2 scores than STICH patients, mortality (3.5%) was lower than that of STICH (4.8%), suggesting a possible decrease in postoperative mortality over the past decade. CONCLUSIONS: The 30-day postoperative mortality risk of coronary artery bypass grafting in patients with left ventricular dysfunction varies markedly. Both the STS and ES2 score are effective in evaluating risk, although the STS score tend to underestimate risk. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00023595.
BACKGROUND: The STICH trial (Surgical Treatment for Ischemic Heart Failure) demonstrated a survival benefit of coronary artery bypass grafting in patients with ischemic cardiomyopathy and left ventricular dysfunction. The Society of Thoracic Surgeons (STS) risk score and the EuroSCORE-2 (ES2) are used for risk assessment in cardiac surgery, with little information available about their accuracy in patients with left ventricular dysfunction. We assessed the ability of the STS score and ES2 to evaluate 30-day postoperative mortality risk in STICH and a contemporary cohort (CC) of patients with a left ventricle ejection fraction ≤35% undergoing coronary artery bypass grafting outside of a trial setting. METHODS AND RESULTS: The STS and ES2 scores were calculated for 814 STICH patients and 1246 consecutive patients in a CC. There were marked variations in 30-day postoperative mortality risk from 1 patient to another. The STS scores consistently calculated lower risk scores than ES2 (1.5 versus 2.9 for the CC and 0.9 versus 2.4 for the STICH cohort), and underestimated postoperative mortality risk. The STS and ES2 scores had moderately good C statistics: CC (0.727, 95% CI: 0.650-0.803 for STS, and 0.707, 95% CI: 0.620-0.795 for ES2); STICH (0.744, 95% CI: 0.677-0.812, for STS and 0.736, 95% CI: 0.665-0.808 for ES2). Despite the CC patients having higher STS and ES2 scores than STICH patients, mortality (3.5%) was lower than that of STICH (4.8%), suggesting a possible decrease in postoperative mortality over the past decade. CONCLUSIONS: The 30-day postoperative mortality risk of coronary artery bypass grafting in patients with left ventricular dysfunction varies markedly. Both the STS and ES2 score are effective in evaluating risk, although the STS score tend to underestimate risk. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00023595.
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Authors: Michael B Tsang; J D Schwalm; Sumeet Gandhi; Matthew G Sibbald; Amiram Gafni; Mathew Mercuri; Omid Salehian; Andre Lamy; Dan Pericak; Sanjit Jolly; Tej Sheth; Craig Ainsworth; James Velianou; Nicholas Valettas; Shamir Mehta; Natalia Pinilla; Bobby Yanagawa; Li Zhang; Victor Chu; Dominic Parry; Richard Whitlock; Adel Dyub; Irene Cybulsky; Lloyd Semelhago; Kostas Ioannou; Adnan Hameed; Douglas Wright; Amin Mulji; Saeed Darvish-Kazem; Nandini Gupta; Ahmed Alshatti; Madhu K Natarajan Journal: JAMA Netw Open Date: 2020-08-03