Predictive ability of EuroSCORE II integrating cardiactroponin T in patients undergoing OPCABG

Abstract

Background Preoperative risk evaluation systems are significant and important to the allocation of medical resources and the communication between doctors and patients. The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is widely used in clinical practice. Cardiac troponin T (cTnT) can specifically and accurately reflect myocardial injury. Whether EuroSCORE II can improve the predictive power after integrating with cTnT is still unclear. This study was a retrospective single center study designed to assess the predictive ability of EuroSCORE II integrated with cTnT for patients undergoing isolated off-pump coronary artery bypass grafting (OPCABG). Methods This retrospective and observational cohort study included 1887 patients who underwent first isolated OPCABG. cTnT was detected within 48 h before operation in each patient. According to myocardial injury, patients were divided by cTnT into 4 stages. A new risk evaluation system was created through logistic regression with EuroSCORE II and myocardial injury classification as covariates. Then the two risk evaluation systems were comparatively assessed by regression analysis, receiver operator characteristic curves, net reclassification index, Bland–Altman plots and decision curve analysis. Results There were 43 in-hospital deaths, with a mortality of 2.30% (43/1887). The logistic regression analysis showed that preoperative myocardial injury classification was a significant risk factor for in-hospital mortality in both total cohort (OR 1.491, 95%CI 1.049–2.119) and subsets (OR 1.761, 95%CI 1.102–2.814). The new risk evaluation system has higher calibration and discrimination power than EuroSCORE II, both for overall cohort and subsets. Especially, the new system has obvious advantages in discrimination power in the subset of acute myocardial infarction (AUC 0.813 vs. 0.772, 0.906 vs. 0.841, and 0.715 vs. 0.646, respectively). Conclusions Both myocardial injury classification and EuroSCORE II are independent risk factors of in-hospital mortality in OPCABG patients. The new risk evaluation system has higher predictive ability than EuroSCORE II, especially in patients with a recent history of AMI.

Predictive Ability of European Heart Surgery Risk Assessment System II (EuroSCORE II) and the Society of Thoracic Surgeons (STS) Score for in-Hospital and Medium-Term Mortality of Patients Undergoing Coronary Artery Bypass Grafting

“… 4 In a previous clinical observational study, we found that EuroSCORE II could improve the prediction of in-hospital death in patients with off-pump CABG after integrating preoperative myocardial injury marker. 32 Another previous study demonstrates that peak and peak time occurrences of perioperative myocardial injury markers are related to mid-term outcomes. 33 The short-term, mid-term, and long-term prognosis outcomes after operation are affected by disease characteristics, treatment methods, underlying diseases, age, and even gender, which are very complicated.…”

CAROTIDSCORE.RU—The first Russian computer program for risk stratification of postoperative complications of carotid endarterectomy

“…15,16,27,28 To overcome these limitations, an updated version of the scale was created-Euro SCORE II, modeled in modern conditions, in a group of 22,381 patients in 150 clinics from 43 countries. [9][10][11][12][13] However, a number of researchers agree that Euro SCORE II underestimates the mortality rate and risks of complications in the high-risk group of patients, and also does not take into account the anatomical component of atherosclerotic lesions of the coronary arteries. 15,16,27,28 The Euro SCORE scale took into account the following patient risk factors: age, height, sex, body weight, the presence of concomitant pathology (chronic obstructive pulmonary disease, MPA), myocardial contractility, the urgency of the operation, the presence of endocarditis, previous cardiac surgery, pulmonary artery pressure, features operations (time of cardiopulmonary bypass, time of aortic crossclamping, time of circulatory arrest), critical condition of the patient before surgery, renal dysfunction, decreased plasma protein level, symptoms of the disease (functional class of angina pectoris and heart failure).…”

“…[6][7][8] Currently, there are two popular interactive calculators for determining the probability of developing adverse cardiovascular events after interventions on the cardiovascular system-Euro SCORE II and STS Score. [9][10][11][12][13] However, due to their versatility, they do not meet the requirements of personalized medicine. 14,15 Recently, there has been a growing trend of creating such computer programs for each type of revascularization separately.…”

Effects of peak time of myocardial injury biomarkers on mid-term outcomes of patients undergoing OPCABG

“…Traditional MIBs include cTnT, cTnI and CK-MB. The specificity and sensitivity are higher for both cTnT and cTnI than CK-MB [ 5 , 19 , 20 ]. In this study, although the change trends of CK-MB were similar to those of cTnT, the values and occurrence time of CK-MB peaks were not the risk factors of mid-term mortality (Table 2 ).…”