Locally derived system for cardiac operative risk evaluation.

INTRODUCTION: During the last two decades, many authors have found that European Systems for Cardiac Operative Risk Evaluation (additive and logistic models) overestimate the risk in cardiac surgery. The new European model has recently been introduced as an update to previous versions. The aim of the study was to investigate the significance of locally derived system for cardiac operative risk evaluation and to compare its predictive power with the existing European systems. MATERIAL AND METHODS: For developing a local risk prediction model, data from 2681 patients submitted to cardiac surgery at the Institute of Cardiovascular Diseases Vojvodina have thoroughly been collected. Logistic regression analysis was used to construct a local model for prediction of outcome. The evaluation of the local model and three European systems was performed by comparing the observed and expected hospital mortality. RESULTS: The difference between the predicted and observed mortality regardless of the type of surgery was statistically insignificant for the additive European system (p=0.073) and the local model (p=0.134). The logistic European system overestimated the operative risk, while the new European model underestimated mortality. In coronary surgery, all models, except the logistic European system, performed well. In valvular surgery, the new European model and the local model underestimated mortality significantly, while the additive and logistic European models performed well. In combined surgery, the new European system significantly underestimated mortality (p=0.029), while the local model performed well (p=0.252). CONCLUSION: The locally derived model shows satisfactory results, with good calibration and discriminative power. The local model specifically outperforms all other European systems in terms of discriminatory power in combined surgery subset.

Vojvodinascore--local system for cardiac operative risk evaluation.

INTRODUCTION: The aim of the study was to investigate the prognostic value, sensitivity and specificity of both the logistic and additive European System for Cardiac Operative Risk Evaluation (as well as the European System for Cardiac Operative Risk Evaluation II and to assess the necessity for developing a local outcome prediction model in cardiac surgery. MATERIAL AND METHODS: The research included 406 consecutive patients who had undergone cardiac surgical procedures at Institute of Cardiovascular Diseases of Vojvodina from January 2012 to July 2012. The authors compared the predicted mortality according to the additive and logistic European Systems for Cardiac Operative Risk Evaluation, the new European System for Cardiac Operative Risk Evaluation II and the observed mortality (30 days after surgery). RESULTS: The difference between the predicted and observed mortality regarding the whole group of 406 operated cardiac patients was not statistically significant for the additive European System for Cardiac Operative Risk Evaluation (p = 0.081) and the European System for Cardiac Operative Risk Evaluation II (p = 0.164), but it was statistically significant for the logistic European System for Cardiac Operative Risk Evaluation (p = 0.031). The areas under the receiver operating characteristic curves are statistically different from 0.5 for both models (additive and logistic European System for Cardiac Operative Risk Evaluation), as well as for the European System for Cardiac Operative Risk Evaluation II. However, the proper classification of the patients has not been observed since their sensitivity and specificity are not satisfactory. CONCLUSION: The additive and logistic European Systems for Cardiac Operative Risk Evaluation overestimate while the European System for Cardiac Operative Risk Evaluation II underestimates the risk in cardiac surgery. We believe that a locally derived model would be of great use in the everyday clinical practice since it would faithfully illustrate the actual state of patient population of the region where it was developed. At the same time it would provide the accurate prediction of surgical outcome.

[Correlation between acute coronary syndrome, hyperlipoproteinemia and statins].

Atherosclerosis is defined as a chronic, progressive, proliferative and inflammatory process developed as a response of blood vessel endothelium to the numerous noxious factors. The definition, which is only an approximate one, shows that one of the terms to carry definition is progression. In other words, it is a well-known fact today that atherosclerosis is a progressive process. The question about the possibilities of its stagnation and regression arises. The appearance of statins and their introduction into the therapy and the process of prevention give a positive answer to the previous question. The results of many studies have also shown that statins can be used to decrease and even stop the process of atherosclerosis. Using the modern diagnostic procedures, primarily the intravascular and Doppler ultrasound, andfocusing on regression, these studies fillowed the process of atherosclerosis in patients with statin therapy. The conclusions of these studies have indicated a clear degree of regression of atherosclerosis which is not a spectacular one, but implies the significant clinical improvement.