TY - JOUR
TI - The importance of independent risk-factors for long-term mortality
prediction after cardiac surgery
AU - Toumpoulis, I. K.
AU - Anagnostopoulos, C. E.
AU - Ioannidis, J. P. and
AU - Toumpoulis, S. K.
AU - Chamogeorgakis, T.
AU - Swistel, D. G.
AU - DeRose,
AU - J. J.
JO - European Journal of Clinical Investigation
PY - 2006
VL - 36
TODO - 9
SP - 599-607
PB - Wiley-Blackwell
SN - 0014-2972, 1365-2362
TODO - 10.1111/j.1365-2362.2006.01703.x
TODO - cardiac surgery; EuroSCORE; independent predictors; long-term mortality
TODO - Backround The purpose of the present study was to determine independent
predictors for long-term mortality after cardiac surgery. The European
System for Cardiac Operative Risk Evaluation (EuroSCORE) was developed
to score in-hospital mortality and recent studies have shown its ability
to predict long-term mortality as well. We compared forecasts based on
EuroSCORE with other models based on independent predictors.
Methods Medical records of patients with cardiac surgery who were
discharged alive (n = 4852) were retrospectively reviewed. Their
operative surgical risks were calculated according to EuroSCORE.
Patients were randomly divided into two groups: training dataset (n =
3233) and validation dataset (n = 1619). Long-term survival data (mean
follow-up 5.1 years) were obtained from the National Death Index. We
compared four models: standard EuroSCORE (M1); logistic EuroSCORE (M2);
M2 and other preoperative, intra-operative and post-operative selected
variables (M3); and selected variables only (M4). M3 and M4 were
determined with multivariable Cox regression analysis using the training
dataset.
Results The estimated five-year survival rates of the quartiles in
compared models in the validation dataset were: 94.5%, 87.8%, 77.1%,
64.9% for M1; 95.1%, 88.0%, 80.5%, 64.4% for M2; 93.4%, 89.4%,
80.8%, 64.1% for M3; and 95.8%, 90.9%, 81.0%, 59.9% for M4. In the
four models, the odds of death in the highest-risk quartile was 8.4-,
8.5-, 9.4- and 15.6-fold higher, respectively, than the odds of death in
the lowest-risk quartile (P < 0.0001 for all).
Conclusions EuroSCORE is a good predictor of long-term mortality after
cardiac surgery. We developed and validated a model using selected
preoperative, intra-operative and post-operative variables that has
better discriminatory ability.
ER -