SinoSCORE can predict the early mortality of patients with valve surgery / 中华胸心血管外科杂志

Objective To validate the predictive value of SinoSCORE in patients undergoing valve surgery. Methods The clinical data of 13 ±353 patients undergone valve surgery from 43 Chinese cardiac centers between January 2007 and December 2008 were retrospectively analyzed. The score values of all patients were calculated according to the SinoSCORE model.The calibration was tested by the Hosmer-Lemeshow goodness-of-fit statistic. Area under the receiver operator curves ( ROC )was calculated to evaluate the model' s discriminatory ability. Results The mean age of the total patients was (48.0 ± 11.7 )years. Most of the patients were women (58% versus 42% ). The data contained 2505 cases of aortic valve surgery, 6996 cases of mitral valve surgery and 4002 cases of double valve surgery ( concomitant aortic and mitral valve surgery). The area under the ROC (0.74,95% confidence interval 0.70 -0.78 ) revealed that the SinoSCORE possessed strong discriminatory power between high- and low risk patients. The Hosmer-Lemeshow goodness-of-fit test (P = 0.47 ) validated the good predictive ability of SinoSCORE. Conclusion SinoSCORE can accurately predict the early mortality in patients with valve surgery. It is a good and well-validated risk stratification model applicable to patients with valve surgery.

Set up and validation of Chinese Risk Stratification System for Coronary Artery Bypass Grafting / 中华胸心血管外科杂志

Objective Our study aims to evaluate the performance of Chinese risk stratification system for coronary artery bypass grafting (CABG) in the prediction of in-hospital mortality and major postoperative complications after CABG. Methods Clinical information of 9564 consecutive CABG patients was collected in Chinese Coronary Artery Bypass Grafting Registry which recruited 43 centers over China between 2007 and 2008. Sino System for Coronary Operative Risk Evaluation ( SinoSCORE) was developed using the logistic regression model. The SinoSCORE model was designed to predict in-hospital mortality among patients undergoing coronary artery bypass surgery. The scoring system finally identified 11 risk factors including age over 65, preoperative NYHA stage, chronic renal failure, chronic obstructive pulmonary disease, etc. Cut-off point was defined for SinoSCORE model to distinguish low( SinoSCORE: ≤ 1 ), moderate( SinoSCORE :2 -5 ) and high risk groups(≥6).AUC statistic (receiver operating characteristic curve) was used to test discrimination of SinoSCORE model and we assessed calibration of this model by the Hosmer-Lemeshow goodness-of-fit statistic. The above-mentioned results were compared with the European Risk System in Cardiac Operations (EuroSCORE). And we also assessed the applicability of SinoSCORE model in the prediction of in-hospital mortality among the three different risk groups by comparing the 95% confidence interval (CI) between the morbidity observed with that expected. Results SinoSCORE model showed good performance ( HL P ＞ 0. 05, AUC ＞ 0. 70 ) in the prediction of in-hospital mortality and postoperative complications. Of our study population, calibration by Hosmer-Lemeshow (HL) test for in-hospital mortality was P=0.70, discrimination by area under ROC (AUC) was 0.80. And for major postoperative complications, the risk model SinoSCORE model still turned out good including the following: stroke ( HL P = 0. 43, AUC = 0. 76, renal failure ( HL P = 0. 70, AUC = 0. 72 ), prolonged ventilation ( HL P = 0. 18, AUC = 0.70 ),multiple organ failure( HL P =0.49 ,AUC =0.79). By comparison with EuroSCORE model, SinoSCORE model proved better prediction ability in both the discrimination and calibration based on our research crowd. And during the different danger degree of patients, mortality observations 95% CI and estimated values of 95% CI were very good overlap, which indicated that this model for the three different risk groups are applicable. Conclusion SinoSCORE model is based on the newest clinical date of Chinese patients undergoing CABG. SinoSCORE can be used to predict not only in-hospital mortality, for which it was originally designed, but also postoperative complications. SinoSCORE proved better performance than the EuroSCORE model in Chinese CABG patients and is more suitable for? application? among? domestic cardiac surgery? physicians.

The prediction of early mortality in off-pump coronary artery bypass surgery: SinoSCORE versus EuroSCORE / 中华胸心血管外科杂志

Objective To compare the validation of the Sino System for Coronary Operative Risk Evaluation ( SinoSCORE ) with the Europe an system for cardiac operative risk evaluation ( EuroSCORE ) in patients undergoing off-pump coronary artery bypass (OPCAB) surgery in China. Methods Data of patients who underwent OPCAB between 2004 and 2005 in the Chinese coronary artery bypass grafting registry study were collected. The end point of the study was postoperative in-hospital death. Predicted mortality were calculated using the SinoSCORE and the logistic EuroSCORE, and compared with observed mortality. Calibration was evaluated by Hosmer-Lemeshow goodness-of-fit test. Discrimination was tested by determining the area under the receiver operating characteristic(ROC) curve. Results 73 of 4920 patients died in hospital and the observed mortality was 1.48%. The predicted mortality calculated by the SinoSCORE and the EuroSCORE was 2.73% and 4. 13% respectively. For SinoSCORE the Hosmer-Lemeshow test was non-significant ( P = 0. 636 ) and the area under ROC curve was 0. 794. For the EuroSCORE the HL test was significant( P = 0.01 ) and the area under ROC curve was 0. 756. Both the SinoSCORE and the logistic EuroSCORE provides good discrimination, but the SinoSCORE showed better calibration than EuroSCORE, that is, both the two models were significantly correlated to postoperative death, but SinoSCORE is more accurate than EuroSCORE at predicting postoperative in-hospital mortality. Conclusion SinoSCORE seems to be more suitable than EuroSCORE in predicting postoperative in-hospital mortality for OPCAB patients in China.

Validation of the Chinese system for cardiac operative risk evaluation (SinoSCORE) in senior heart surgery patients / 中华胸心血管外科杂志

Objective To validate of the Chinese system for cardiac operative risk evaluation (SinoSCORE) in senior heart surgery patients. Methods Data from 43 Chinese Medical Centers in the period January 2004 through December 2008 were analyzed on 9445 heart surgery patients aged over 65 years. Firstly, risk factors of this series and database of SinoSCORE were compared. Then, the additive score of each patients and the discrimination and calibration of sinoSCORE in elder patients were calculated. Results There were significant differences between the risk factors of patients from two groups. Howerever,the SinoSCORE was able to predict the in-hospital mortality of senior patients with good discrimination ( Hosmer-Lemeshow test,P =0.45 ) and calibration (the area under the receiver operating characteristic curve, 0.73, P ＜ 0.01 ). Conclusion SinoSCORE was able to predict the in-hospital mortality of senior heart surgery patients.