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. 2021 Nov 19:14:8509-8519.
doi: 10.2147/IJGM.S338819. eCollection 2021.

Predictive Ability of European Heart Surgery Risk Assessment System II (EuroSCORE II) and the Society of Thoracic Surgeons (STS) Score for in-Hospital and Medium-Term Mortality of Patients Undergoing Coronary Artery Bypass Grafting

Fei Gao #  1 , Lingtong Shan #  2 , Chong Wang #  3 , Xiaoqi Meng  4 , Jiapeng Chen  5 , Lixiang Han  6 , Yangyang Zhang  3 , Zhi Li  6
Affiliations

Predictive Ability of European Heart Surgery Risk Assessment System II (EuroSCORE II) and the Society of Thoracic Surgeons (STS) Score for in-Hospital and Medium-Term Mortality of Patients Undergoing Coronary Artery Bypass Grafting

Fei Gao et al. Int J Gen Med. .

Abstract

Objective: To evaluate the powers of European Heart Surgery Risk Assessment System II (EuroSCORE II) and the Society of Thoracic Surgeons (STS) score in predicting in-hospital and medium-term mortality of patients undergoing coronary artery bypass grafting (CABG).

Methods: Totally 1628 Chinese patients were included between January 2000 and January 2018. Their perioperative clinical data were collected and the patients were closely followed up. According to the length of follow-up time, the total cohort was divided into 1-year, 2-year, 3-year, 4-year and 5-year groups. The in-hospital and medium-term risk prediction of EuroSCORE II and STS score were comparatively assessed by calibration, discrimination, decision curve analysis (DCA), net reclassification index (NRI), integrated discrimination improvement (IDI) and Bland-Altman analysis.

Results: About 36 (2.21%) patients died during hospitalization. Both EuroSCORE II and STS score performed extremely well in predicting in-hospital mortality (area under curve = 0.900 and 0.879, respectively). However, calibration and discrimination analyses showed gradual decrease when these two risk evaluation systems were used to predict mortality during the follow-up period. At the same time, the predictive ability of EuroSCORE II was better than STS score. DCA curves showed that the performances of the two evaluation systems were roughly equal between the threshold probability of 0% to 20%. The percentage of correct reclassification of EuroSCORE II was 21.64% higher than that of STS score in predicting 2-year postoperative mortality. The IDI index showed that the predictive capabilities of these two systems were roughly equivalent. Bland-Altman analysis showed no significant difference between the values of the two systems.

Conclusion: EuroSCORE II and STS score have excellent predictive powers in predicting in-hospital mortality of patients undergoing CABG. In particular, EuroSCORE II is superior in calibration and discrimination. The prediction efficiency of the two risk evaluation systems is still acceptable for two-year postoperative mortality, but decreases year by year.

Keywords: EuroSCORE II; STS score; coronary artery bypass grafting; in-hospital mortality; medium-term prognosis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Flow chart of patient enrollment.
Figure 2
Figure 2
Calibration curves between EuroSCORE II and STS score. Scatter plots were drawn with the actual mortality of each group as the dependent variable (Y) and the expected mortality rate as the independent variable (X), and the regression line was fitted. The slope of the reference line (gray dotted line) is 1 and the intercept is 0. If the fitted straight line is closer to the reference line, the calibration of the corresponding risk evaluation system is higher. (A1–A6) calibration curves in predicting in-hospital, postoperative one-year, two-year, three-year, four-year and five-year mortality rates respectively.
Figure 3
Figure 3
ROC curves of EuroSCORE II and STS score. (A1–A6) ROC curves of predicting in-hospital, postoperative one-year, two-year, three-year, four-year and five-year mortality rates respectively.
Figure 4
Figure 4
Decision curve analysis of EuroSCORE II and STS score. The gray line represents the net benefits of providing surgery for all patients, assuming that all patients would survive. The black line represents the net benefits of surgery to no patients, assuming that none would survive after operation. The red and blue lines stand for the net benefits of applying surgery to patients according to EuroSCORE II and STS score respectively. (A1–A6) DCA curves of predicting in-hospital, postoperative one-year, two-year, three-year, four-year and five-year mortality rates respectively.
Figure 5
Figure 5
Bland-Altman plots between EuroSCORE II and STS score. The green line represents the mean of the difference between the two risk evaluation systems. The blue line represents the 95% confidence interval. (A1–A6) Bland-Altman plots of predicting in-hospital, postoperative one-year, two-year, three-year, four-year and five-year mortality rates respectively.
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