Applicability of two international risk scores in cardiac surgery in a reference center in Brazil

Arq Bras Cardiol. 2014 Jun;102(6):539-48. doi: 10.5935/abc.20140064. Epub 2014 May 27.
[Article in English, Portuguese]

Abstract

Background: The applicability of international risk scores in heart surgery (HS) is not well defined in centers outside of North America and Europe.

Objective: To evaluate the capacity of the Parsonnet Bernstein 2000 (BP) and EuroSCORE (ES) in predicting in-hospital mortality (IHM) in patients undergoing HS at a reference hospital in Brazil and to identify risk predictors (RP).

Methods: Retrospective cohort study of 1,065 patients, with 60.3% patients underwent coronary artery bypass grafting (CABG), 32.7%, valve surgery and 7.0%, CABG combined with valve surgery. Additive and logistic scores models, the area under the ROC (Receiver Operating Characteristic) curve (AUC) and the standardized mortality ratio (SMR) were calculated. Multivariate logistic regression was performed to identify the RP.

Results: Overall mortality was 7.8%. The baseline characteristics of the patients were significantly different in relation to BP and ES. AUCs of the logistic and additive BP were 0.72 (95% CI, from 0.66 to 0.78 p = 0.74), and of ES they were 0.73 (95% CI; 0.67 to 0.79 p = 0.80). The calculation of the SMR in BP was 1.59 (95% CI; 1.27 to 1.99) and in ES, 1.43 (95% CI; 1.14 to 1.79). Seven RP of IHM were identified: age, serum creatinine > 2.26 mg/dL, active endocarditis, systolic pulmonary arterial pressure > 60 mmHg, one or more previous HS, CABG combined with valve surgery and diabetes mellitus.

Conclusion: Local scores, based on the real situation of local populations, must be developed for better assessment of risk in cardiac surgery.

Publication types

  • Evaluation Study

MeSH terms

  • Aged
  • Brazil
  • Coronary Artery Bypass / mortality*
  • Female
  • Heart Valve Diseases / surgery*
  • Hospital Mortality*
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Postoperative Complications
  • Reference Values
  • Reproducibility of Results
  • Retrospective Studies
  • Risk Assessment / methods*
  • Risk Factors
  • Sensitivity and Specificity