Society of Thoracic Surgeons Risk Score and EuroSCORE-2 Appropriately Assess 30-Day Postoperative Mortality in the STICH Trial and a Contemporary Cohort of Patients With Left Ventricular Dysfunction Undergoing Surgical Revascularization

STICH Trial Investigators

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The STICH trial (Surgical Treatment for Ischemic Heart Failure) demonstrated a survival benefit of coronary artery bypass grafting in patients with ischemic cardiomyopathy and left ventricular dysfunction. The Society of Thoracic Surgeons (STS) risk score and the EuroSCORE-2 (ES2) are used for risk assessment in cardiac surgery, with little information available about their accuracy in patients with left ventricular dysfunction. We assessed the ability of the STS score and ES2 to evaluate 30-day postoperative mortality risk in STICH and a contemporary cohort (CC) of patients with a left ventricle ejection fraction ≤35% undergoing coronary artery bypass grafting outside of a trial setting. METHODS AND RESULTS: The STS and ES2 scores were calculated for 814 STICH patients and 1246 consecutive patients in a CC. There were marked variations in 30-day postoperative mortality risk from 1 patient to another. The STS scores consistently calculated lower risk scores than ES2 (1.5 versus 2.9 for the CC and 0.9 versus 2.4 for the STICH cohort), and underestimated postoperative mortality risk. The STS and ES2 scores had moderately good C statistics: CC (0.727, 95% CI: 0.650-0.803 for STS, and 0.707, 95% CI: 0.620-0.795 for ES2); STICH (0.744, 95% CI: 0.677-0.812, for STS and 0.736, 95% CI: 0.665-0.808 for ES2). Despite the CC patients having higher STS and ES2 scores than STICH patients, mortality (3.5%) was lower than that of STICH (4.8%), suggesting a possible decrease in postoperative mortality over the past decade. CONCLUSIONS: The 30-day postoperative mortality risk of coronary artery bypass grafting in patients with left ventricular dysfunction varies markedly. Both the STS and ES2 score are effective in evaluating risk, although the STS score tend to underestimate risk. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00023595.

Original languageEnglish (US)
Pages (from-to)e005531
JournalCirculation. Heart failure
Volume11
Issue number11
DOIs
StatePublished - Nov 1 2018

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Left Ventricular Dysfunction
Thorax
Mortality
Coronary Artery Bypass
Surgeons
Cardiomyopathies
Thoracic Surgery
Heart Ventricles
Heart Failure
Clinical Trials
Survival

Keywords

  • coronary artery bypass
  • coronary artery disease
  • heart failure
  • risk stratification

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{c79cfd34d1cd4629a9e06d5d46fe09d9,
title = "Society of Thoracic Surgeons Risk Score and EuroSCORE-2 Appropriately Assess 30-Day Postoperative Mortality in the STICH Trial and a Contemporary Cohort of Patients With Left Ventricular Dysfunction Undergoing Surgical Revascularization",
abstract = "BACKGROUND: The STICH trial (Surgical Treatment for Ischemic Heart Failure) demonstrated a survival benefit of coronary artery bypass grafting in patients with ischemic cardiomyopathy and left ventricular dysfunction. The Society of Thoracic Surgeons (STS) risk score and the EuroSCORE-2 (ES2) are used for risk assessment in cardiac surgery, with little information available about their accuracy in patients with left ventricular dysfunction. We assessed the ability of the STS score and ES2 to evaluate 30-day postoperative mortality risk in STICH and a contemporary cohort (CC) of patients with a left ventricle ejection fraction ≤35{\%} undergoing coronary artery bypass grafting outside of a trial setting. METHODS AND RESULTS: The STS and ES2 scores were calculated for 814 STICH patients and 1246 consecutive patients in a CC. There were marked variations in 30-day postoperative mortality risk from 1 patient to another. The STS scores consistently calculated lower risk scores than ES2 (1.5 versus 2.9 for the CC and 0.9 versus 2.4 for the STICH cohort), and underestimated postoperative mortality risk. The STS and ES2 scores had moderately good C statistics: CC (0.727, 95{\%} CI: 0.650-0.803 for STS, and 0.707, 95{\%} CI: 0.620-0.795 for ES2); STICH (0.744, 95{\%} CI: 0.677-0.812, for STS and 0.736, 95{\%} CI: 0.665-0.808 for ES2). Despite the CC patients having higher STS and ES2 scores than STICH patients, mortality (3.5{\%}) was lower than that of STICH (4.8{\%}), suggesting a possible decrease in postoperative mortality over the past decade. CONCLUSIONS: The 30-day postoperative mortality risk of coronary artery bypass grafting in patients with left ventricular dysfunction varies markedly. Both the STS and ES2 score are effective in evaluating risk, although the STS score tend to underestimate risk. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00023595.",
keywords = "coronary artery bypass, coronary artery disease, heart failure, risk stratification",
author = "{STICH Trial Investigators} and Nadia Bouabdallaoui and Stevens, {Susanna R.} and Torsten Doenst and Petrie, {Mark C.} and Nawwar Al-Attar and Ali, {Imtiaz S.} and Ambrosy, {Andrew P.} and Barton, {Anna K.} and Raymond Cartier and Alexander Cherniavsky and Pierre Demondion and Patrice Desvigne-Nickens and Favaloro, {Robert R.} and Sinisa Gradinac and Petra Heinisch and Anil Jain and Marek Jasinski and Jerome Jouan and Kalil, {Renato A.K.} and Lorenzo Menicanti and Michler, {Robert E.} and Vivek Rao and Smith, {Peter K.} and Marian Zembala and Velazquez, {Eric J.} and Al-Khalidi, {Hussein R.} and Rouleau, {Jean L.}",
year = "2018",
month = "11",
day = "1",
doi = "10.1161/CIRCHEARTFAILURE.118.005531",
language = "English (US)",
volume = "11",
pages = "e005531",
journal = "Circulation: Heart Failure",
issn = "1941-3297",
publisher = "Lippincott Williams and Wilkins",
number = "11",

}

TY - JOUR

T1 - Society of Thoracic Surgeons Risk Score and EuroSCORE-2 Appropriately Assess 30-Day Postoperative Mortality in the STICH Trial and a Contemporary Cohort of Patients With Left Ventricular Dysfunction Undergoing Surgical Revascularization

AU - STICH Trial Investigators

AU - Bouabdallaoui, Nadia

AU - Stevens, Susanna R.

AU - Doenst, Torsten

AU - Petrie, Mark C.

AU - Al-Attar, Nawwar

AU - Ali, Imtiaz S.

AU - Ambrosy, Andrew P.

AU - Barton, Anna K.

AU - Cartier, Raymond

AU - Cherniavsky, Alexander

AU - Demondion, Pierre

AU - Desvigne-Nickens, Patrice

AU - Favaloro, Robert R.

AU - Gradinac, Sinisa

AU - Heinisch, Petra

AU - Jain, Anil

AU - Jasinski, Marek

AU - Jouan, Jerome

AU - Kalil, Renato A.K.

AU - Menicanti, Lorenzo

AU - Michler, Robert E.

AU - Rao, Vivek

AU - Smith, Peter K.

AU - Zembala, Marian

AU - Velazquez, Eric J.

AU - Al-Khalidi, Hussein R.

AU - Rouleau, Jean L.

PY - 2018/11/1

Y1 - 2018/11/1

N2 - BACKGROUND: The STICH trial (Surgical Treatment for Ischemic Heart Failure) demonstrated a survival benefit of coronary artery bypass grafting in patients with ischemic cardiomyopathy and left ventricular dysfunction. The Society of Thoracic Surgeons (STS) risk score and the EuroSCORE-2 (ES2) are used for risk assessment in cardiac surgery, with little information available about their accuracy in patients with left ventricular dysfunction. We assessed the ability of the STS score and ES2 to evaluate 30-day postoperative mortality risk in STICH and a contemporary cohort (CC) of patients with a left ventricle ejection fraction ≤35% undergoing coronary artery bypass grafting outside of a trial setting. METHODS AND RESULTS: The STS and ES2 scores were calculated for 814 STICH patients and 1246 consecutive patients in a CC. There were marked variations in 30-day postoperative mortality risk from 1 patient to another. The STS scores consistently calculated lower risk scores than ES2 (1.5 versus 2.9 for the CC and 0.9 versus 2.4 for the STICH cohort), and underestimated postoperative mortality risk. The STS and ES2 scores had moderately good C statistics: CC (0.727, 95% CI: 0.650-0.803 for STS, and 0.707, 95% CI: 0.620-0.795 for ES2); STICH (0.744, 95% CI: 0.677-0.812, for STS and 0.736, 95% CI: 0.665-0.808 for ES2). Despite the CC patients having higher STS and ES2 scores than STICH patients, mortality (3.5%) was lower than that of STICH (4.8%), suggesting a possible decrease in postoperative mortality over the past decade. CONCLUSIONS: The 30-day postoperative mortality risk of coronary artery bypass grafting in patients with left ventricular dysfunction varies markedly. Both the STS and ES2 score are effective in evaluating risk, although the STS score tend to underestimate risk. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00023595.

AB - BACKGROUND: The STICH trial (Surgical Treatment for Ischemic Heart Failure) demonstrated a survival benefit of coronary artery bypass grafting in patients with ischemic cardiomyopathy and left ventricular dysfunction. The Society of Thoracic Surgeons (STS) risk score and the EuroSCORE-2 (ES2) are used for risk assessment in cardiac surgery, with little information available about their accuracy in patients with left ventricular dysfunction. We assessed the ability of the STS score and ES2 to evaluate 30-day postoperative mortality risk in STICH and a contemporary cohort (CC) of patients with a left ventricle ejection fraction ≤35% undergoing coronary artery bypass grafting outside of a trial setting. METHODS AND RESULTS: The STS and ES2 scores were calculated for 814 STICH patients and 1246 consecutive patients in a CC. There were marked variations in 30-day postoperative mortality risk from 1 patient to another. The STS scores consistently calculated lower risk scores than ES2 (1.5 versus 2.9 for the CC and 0.9 versus 2.4 for the STICH cohort), and underestimated postoperative mortality risk. The STS and ES2 scores had moderately good C statistics: CC (0.727, 95% CI: 0.650-0.803 for STS, and 0.707, 95% CI: 0.620-0.795 for ES2); STICH (0.744, 95% CI: 0.677-0.812, for STS and 0.736, 95% CI: 0.665-0.808 for ES2). Despite the CC patients having higher STS and ES2 scores than STICH patients, mortality (3.5%) was lower than that of STICH (4.8%), suggesting a possible decrease in postoperative mortality over the past decade. CONCLUSIONS: The 30-day postoperative mortality risk of coronary artery bypass grafting in patients with left ventricular dysfunction varies markedly. Both the STS and ES2 score are effective in evaluating risk, although the STS score tend to underestimate risk. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00023595.

KW - coronary artery bypass

KW - coronary artery disease

KW - heart failure

KW - risk stratification

UR - http://www.scopus.com/inward/record.url?scp=85058912810&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85058912810&partnerID=8YFLogxK

U2 - 10.1161/CIRCHEARTFAILURE.118.005531

DO - 10.1161/CIRCHEARTFAILURE.118.005531

M3 - Article

VL - 11

SP - e005531

JO - Circulation: Heart Failure

JF - Circulation: Heart Failure

SN - 1941-3297

IS - 11

ER -