Assessment of three risk evaluation systems for patients aged ≥70 in East China: performance of SinoSCORE, EuroSCORE II and the STS risk evaluation system

Lingtong Shan; Wen Ge; Yiwei Pu; Hong Cheng; Zhengqiang Cang; Xing Zhang; Qifan Li; Anyang Xu; Qi Wang; Chang Gu; Yangyang Zhang

doi:10.7717/peerj.4413

Assessment of three risk evaluation systems for patients aged ≥70 in East China: performance of SinoSCORE, EuroSCORE II and the STS risk evaluation system

PeerJ. 2018 Feb 23:6:e4413. doi: 10.7717/peerj.4413. eCollection 2018.

Authors

Lingtong Shan^#¹, Wen Ge^#², Yiwei Pu^#¹, Hong Cheng^#³, Zhengqiang Cang¹, Xing Zhang¹, Qifan Li¹, Anyang Xu⁴, Qi Wang¹, Chang Gu⁵, Yangyang Zhang^{6

7

8}

Affiliations

¹ The First Clinical Medical College, Nanjing Medical University, Nanjing, China.
² Department of Cardiothoracic Surgery, Shuguang Hospital affiliated to Shanghai University of TCM, Shanghai, China.
³ Department of Neurology, Jiangsu Province People's Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
⁴ Department of Chronic and Noncommunicable Disease, Shanghai Changning District Center for Disease Control and Prevention, Shanghai, China.
⁵ Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai JiaoTong University, Shanghai, China.
⁶ Key Laboratory of Arrhythmias of the Ministry of Education of China, East Hospital, Tongji University School of Medicine, Shanghai, China.
⁷ Department of Cardiovascular Surgery, East Hospital, Tongji University School of Medicine, Shanghai, China.
⁸ Department of Thoracic and Cardiovascular Surgery, Jiangsu Province People's Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.

^# Contributed equally.

Abstract

Objectives: To assess and compare the predictive ability of three risk evaluation systems (SinoSCORE, EuroSCORE II and the STS risk evaluation system) in patients aged ≥70, and who underwent coronary artery bypass grafting (CABG) in East China.

Methods: Three risk evaluation systems were applied to 1,946 consecutive patients who underwent isolated CABG from January 2004 to September 2016 in two hospitals. Patients were divided into two subsets according to their age: elderly group (age ≥70) with a younger group (age <70) used for comparison. The outcome of interest in this study was in-hospital mortality. The entire cohort and subsets of patients were analyzed. The calibration and discrimination in total and in subsets were assessed by the Hosmer-Lemeshow and the C statistics respectively.

Results: Institutional overall mortality was 2.52%. The expected mortality rates of SinoSCORE, EuroSCORE II and the STS risk evaluation system were 0.78(0.64)%, 1.43(1.14)% and 0.78(0.77)%, respectively. SinoSCORE achieved the best discrimination (the area under the receiver operating characteristic curve (AUC) = 0.829), followed by the STS risk evaluation system (AUC = 0.790) and EuroSCORE II (AUC = 0.769) in the entire cohort. In the elderly group, the observed mortality rate was 4.82% while it was 1.38% in the younger group. SinoSCORE (AUC = .829) also achieved the best discrimination in the elderly group, followed by the STS risk evaluation system (AUC = .730) and EuroSCORE II (AUC = 0.640) while all three risk evaluation systems all had good performances in the younger group. SinoSCORE, EuroSCORE II and the STS risk evaluation system all achieved positive calibrations in the entire cohort and subsets.

Conclusion: The performance of the three risk evaluation systems was not ideal in the entire cohort. In the elderly group, SinoSCORE appeared to achieve better predictive efficiency than EuroSCORE II and the STS risk evaluation system.

Keywords: Coronary artery bypass grafting; Elderly; EuroSCORE II; Risk evaluation system; STS score; SinoSCORE.

Grants and funding

This work was supported by Six major talent Summit of Jiangsu Province (2015-WSW-019 to Yangyang Zhang) and the practice innovation training program projects for the Jiangsu students in college (201610312011Z to Lingtong Shan) (201510312073Z to Zhengqiang Cang). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.