Analysis of predictive efficacy of EuroSCORE Ⅱ and SinoSCORE for patients undergoing coronary bypass surgery in single center / 天津医药

@#Objective TocomparethepredictiveefficacyofEuroSCOREⅡandSinoSCOREinthepostoperative mortalityofChinesepatientsunderwentcoronaryarterybypassgrafting(CABG). Methods Theclinicaldataof4507 patientswithCABGatourdepartmentinJanuary2011andApril2015wereretrospectivelyanalyzed.Cardiovascularrisk stratificationwasperformedonpatientsusingEuroSCOREⅡandSinoSCORE.PatientsweredividedintoⅠ,Ⅱ,ⅢandⅣ groupsaccordingtothepredictedfatalityrates.Themortalityrateswerepredictedinallgroupsofpatientsrespectively. Predictive effectiveness was analyzed by the analysis of discernment and calibration force. Results The in-hospital mortalityratewas1.35%inallpatients,whilethemeanmortalityratepredictedbyEuroSCOREⅡwas1.470%±1.215% (95%CI：1.43-1.50), and predicted by SinoSCORE was 2.860%±3.454% (95% CI：2.76-2.96). The AUC values of EuroSCOREⅡandSinoSCOREwere0.728and0.716.ItwasfoundthatthecalibrationdegreeofEuroSCOREⅡwaspoor andSinoSCOREwasacceptabledetectedbyHosmer-LemeshowTest.EuroSCOREⅡunderestimatedthemortalityratesof groupⅣ,butoverestimatedmortalityratesinothergroupsofpatients.SinoSCOREunderestimatedmortalityratesofpatients ingroupⅠandoverestimatedmortalityratesinothergroupsofpatients.EuroSCOREⅡonlyachievedgooddiscrimination forpatientsofgroupⅠ(AUC=0.707),andSinoSCOREachievedgooddiscriminationforpatientsofgroupⅡ(AUC=0.754). EuroSCOREⅡoverestimatedthemortalityrateintheisolatedCABGgroupandunderestimatedmortalityratesinpatients withothercardiacsurgeries.SinoSCOREoverestimatedmortalityratesingroupⅡ.TheAUCvaluesofEuroSCOREⅡand SinoSCOREwere0.694and0.687inisolatedCABGgroup.TheAUCvaluesofEuroSCOREⅡandSinoSCOREwere0.772 and0.669inCABGcombinedwithothercardiacsurgeries.Conclusion EuroSCOREⅡhasagoodpredictiveefficacyin theentiregroupofpatientsandⅠ,ⅡandⅢgroups,buthasapoorperformanceingroupⅣ.SinoSCOREoverestimates mortalityratesintheentiregroupandⅠ,ⅡandⅢgroups,anditunderestimatesmortalityratesinpatientsofgroupⅠ. Theapplicationandestablishmentofriskmodelsshouldfocusondifferentheartdiseasesanddifferentrisklevels,andthe modelingmethodofestablishedrisksystemsneedstobeimproved.

Prognosis and Risk Factors of PCI-treated Senile Patients with Unprotected Left Main Coronary Artery Disease: A Follow-up Study / 医学研究杂志

Objective To study the prognosis and risk factors of senile patients with unprotected left main coronary artery (ULMCA) disease treated with PCI.Methods Patients with ULMCA undergoing PCI from a single center were enrolled in the study.All patients were older than 60.The baseline characteristics were collected and the prognosis and risk factors of the patients were followed-up.All the major adverse cardiovascular and cerebrovascular events (MACCE) were evaluated throughout the follow-up period.Based on those data,Kaplan-Meier curves were plotted and Cox multivariate regression analysis was performed to assess the prognosis and identify risk factors.Results A total of 182 consecutive patients were recruited and followed up with a mean follow-up time of 21.5 (13,36.5) months and an estimated median MACCE-free survival time of 66 months by K-M method.During the follow up,all-cause mortality,non-fatal myocardial infarction,non-fatal cerebrovascular events and target vessel revascularization rates were 6.59％,0.55％,0.55％ and 15.93％ respectively,the incidence of all MACCE was 23.63％.A percentage of 72.09 of the MACCEs had occurred in the first 2 years after the PCI.According to the multivariate-adjusted Cox regression analysis,diameter of left main stent (HR =0.37,95％ CI:0.17-0.82,P =0.014),bifurcation lesion (HR =1.92,95％ CI:1.O1-3.62,P =0.045),smoking index ＞ 50pack / year (HR =3.78;95％ CI:1.29-11.05,P =0.015) were the independent risk factors of MACCE.EuroSCORE Ⅱ ≥2％ (HR =3.96,95％ CI:1.15-13.61,P =0.029) was the independent risk factor of all-cause death.Conclusion The prognosis of PCI-treated ULMCA disease is generally favorable.Most MACCEs occurred in the first 2 years after the PCI.Small left main stents diameter,bifurcation lesions,smoking index ＞ 50 pack/year and EuroSCORE Ⅱ ≥2％ were the risk factors for poor prognosis in patients with ULMCA disease.

The validation of EuroSCORE Ⅱ in predicting the mid-term outcome of patients undergoing Sun's procedure for Stanford type A dissection / 中华胸心血管外科杂志

Objective EuroSCORE is a widely used objective risk scoring model.The aim of this study was to evaluate the validation of EuroSCORE Ⅱ in predicting mid-term survival after total aortic arch replacement with stented elephant trunk implantation(sun' s procedure) for Stanford Type A aortic dissection.Methods Total 90 patients entered the study randomly.All the patients underwent aortic surgery using total aortic arch replacement with stented elephant trunk implantation (Sun's procedure).The patients were divided into three groups based on the predicting mortality by EuroSCORE Ⅱ.Ggroup 1:0 ＜:P ≤ 5 ％,Group 2:5 ％ ＜ P ≤ 10％,Group 3:P ＞ 10％.Kaplan-Meier method was used to evaluate the long term survival of three groups.Receiver operating characteristic curve was used to test discrimination of the EuroSCORE.Calibration was assessed with a Hosmer-Lemeshow goodness-offit statistic.Results 87 patients were followed umil October,2013.The mean follow-up time was(33.32 ± 11.11) months.Total 5 patients died during the follow-up time.Three patients died in group 1,2 patients died in group 2 and 1 in group 3.There was no statistical difference for the mid-term survival rate between 3 groups (P =0.054).Conclusion Although EuroSCORE Ⅱ is the newest risk model for cardiac surgery,it is not accurate when it is applied for predicting mid-term survival after aortic surgery.A new risk evaluating system specially designed for aortic surgery should be developed in the future.