Acquired cardiovascular disease
AusSCORE II in predicting 30-day mortality after isolated coronary artery bypass grafting in Australia and New Zealand

https://doi.org/10.1016/j.jtcvs.2014.02.027Get rights and content
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Objectives

To update the Australian System for Cardiac Operative Risk Evaluation (AusSCORE) model for operative estimation of 30-day mortality risk after isolated coronary artery bypass grafting in the Australian population.

Methods

Data were collected by the Australian and New Zealand Society of Cardiac and Thoracic Surgeons registry from 2001 to 2011 in 25 hospitals. A total of 31,250 patients underwent isolated coronary artery bypass grafting and the outcome was 30-day mortality. A total of 2154 (6.9%) patients had 1 or multiple missing values. Missing values were estimated assuming missing completely at random and logistic regression with a generalized estimating equation was used to address within-hospital variance. Bootstrapping methods were used to construct and validate the updated model (AusSCORE II). Also the model was validated on an out-of-creation sample of 4700 patients who underwent bypass surgery in 2012.

Results

The average age of the patients was 65.6 ± 12.9 years and 78.6% were male. Thirteen variables were selected in the updated model. The bootstrap discrimination and calibration of the AusSCORE II was very good (receiver operating characteristics [ROC], 82.0%; slope calibration, 0.987). The overall observed/AusSCORE II predicted mortality was 1.63% compared with the original AusSCORE predicted mortality of 1.01%. The validation of the AusSCORE II on the out-of-sample data also showed a high performance of the model (ROC, 84.5%; Hosmer-Lemoshow P value, .7654).

Conclusions

The AusSCORE II model provides improved prediction of 30-day mortality and successfully stratifies patient risk. The model will be useful to improve the preoperative consultation regarding risk stratification in terms of 30-day mortality.

CTSNet classification

23.1.4

Abbreviations and Acronyms

AIC
Akaike Information Criteria
ANZSCTS
Australian and New Zealand Society of Cardiac and Thoracic Surgeons
AusSCORE
Australian System for Cardiac Operative Risk Evaluation
CABG
coronary artery bypass grafting
eGFR
glomerular filtration rate
EuroSCORE
European System for Cardiac Operative Risk Evaluation
H-L
Hosmer-Lemoshow
IV
intravenous
MI
myocardial infarction
NYHA
New York Heart Association
RAMR
risk adjusted mortality ratio
ROC
receiver operating characteristics
STS
Society of Thoracic Surgeons

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Disclosures: Authors have nothing to disclose with regard to commercial support.