SinoSCORE: a logistically derived additive prediction model for post-coronary artery bypass grafting in-hospital mortality in a Chinese population

doi:10.1007/s11684-013-0284-0

Front Med

2013, Vol. 7

Issue (4) : 477-485 https://doi.org/10.1007/s11684-013-0284-0

RESEARCH ARTICLE

SinoSCORE: a logistically derived additive prediction model for post-coronary artery bypass grafting in-hospital mortality in a Chinese population

Zhe Zheng(

), Lu Zhang, Xi Li, Shengshou Hu(

), on behalf of the Chinese CABG Registry Study

Department of Cardiovascular Surgery and State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China

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Abstract

This study aims to construct a logistically derived additive score for predicting in-hospital mortality risk in Chinese patients undergoing coronary artery bypass surgery (CABG). Data from 9839 consecutive CABG patients in 43 Chinese centers were collected between 2007 and 2008 from the Chinese Coronary Artery Bypass Grafting Registry. This database was randomly divided into developmental and validation subsets (9:1). The data in the developmental dataset were used to develop the model using logistic regression. Calibration and discrimination characteristics were assessed using the validation dataset. Thresholds were defined for each model to distinguish different risk groups. After excluding 275 patients with incomplete information, the overall mortality rate of the remaining 9564 patients was 2.5%. The SinoSCORE model was constructed based on 11 variables: age, preoperative NYHA stage III or IV, chronic renal failure, extracardiac arteriopathy, chronic obstructive pulmonary disease, preoperative atrial fibrillation or flutter (within 2βweeks), left ventricular ejection fraction, other elective surgery, combined valve procedures, preoperative critical state, and BMI. In the developmental dataset, calibration using a Hosmer-Lemeshow (HL) test was at P =β0.44 and discrimination based on the area under the receiver operating characteristic curve (ROC) was 0.80. In the validation dataset, the HL test was at P =β0.34 and the area under the ROC (AUC) was 0.78. A logistically derived additive model for predicting in-hospital mortality among Chinese patients undergoing CABG was developed based on the most up-to-date multi-center data from China.

Keywords coronary artery bypass grafting risk stratification in-hospital mortality

Corresponding Author(s): Zheng Zhe,Email:zhengzhe@fuwai.com; Hu Shengshou,Email:shengshouhu@yahoo.com

Issue Date: 05 December 2013

Cite this article:

Lu Zhang,on behalf of the Chinese CABG Registry Study,Xi Li, et al. SinoSCORE: a logistically derived additive prediction model for post-coronary artery bypass grafting in-hospital mortality in a Chinese population[J]. Front Med, 2013, 7(4): 477-485.

URL:

https://academic.hep.com.cn/fmd/EN/10.1007/s11684-013-0284-0
https://academic.hep.com.cn/fmd/EN/Y2013/V7/I4/477

Variable	Definition
Gender
Age	In years at most recent birthday
Height
Weight
BMI	Body mass index
BSA	Body surface area
History of smoking	Prior history of smoking, regardless of whether the patients quit smoking
Family history of coronary artery diseases	Immediate family members diagnosed with coronary artery diseases or had sudden cardiac death with unknown etiology before the age of 55βyears old
Diabetes mellitus	Documented past history or fulfilled the criteria of WHO 1999
Hyperlipidemia	Documented past history or TC>5.18 mmol/L, and/or LDL≥3.37 mmol/L, and/or HDL<0.78 mmol/L, and/or triglyceride>1.69 mmol/L
Hypertension	Documented past history or SBP>140 mmHg and/or DBP>90 mmHg
Chronic renal failure	Documented past history or any previous serum creatinine>176 μmol/L
Cerebrovascular accident	Documented past history of coma≥24 h or central nervous system dysfunction≥72 h
Endocarditis	Documented history or diagnosed with blood culture and UCG
COPD	Long-term use of bronchodilators or steroids for lung disease
Immunosuppressive therapy	Any immunosuppressive therapy within 30βdays before surgery
Extracardiac arteriopathy	Any one or more of the following: claudication, carotid occlusion or>50% stenosis, previous or planned intervention on the abdominal aorta, limb arteries, and carotid arteries
Previous cardiac surgery	Requiring opening of the pericardium
Previous CABG	Requiring opening of the pericardium
Previous valve surgery	Surgical procedures with either valve
Previous percutaneous balloon valvuloplasty	Documented history
Previous PCI	Documented history
Previous permanent pacemaker implantation	Documented history
Previous history of non-cardiac surgery	Documented history
History of myocardial infarction	Documented history or ECG evidence
Recent myocardial infarction	<21βdays
Heart failure	Within 2βweeks
Unstable angina	Resting angina requiring i.v. nitrates until arrival in the anesthetic room
Cardiogenic shock	Lasting until arrival in the anesthetic room
Cardiopulmonary resuscitation	Within 2βh
Preoperative persistent ventricular tachycardia or fibrillation	Within 2weeks
Preoperative III auriculo-ventricular block (AVB)	Within 2βweeks
Preoperative atrial fibrillation or flutter	Within 2βweeks
Preoperative critical stage	Any one or more of the following: preoperative cardiogenic shock, ventricular fibrillation or flutter, and preoperative IABP implantation
NYHA staging	NYHA definition
Killip staging	For patients with acute MI
CCS staging	For patients with angina
Serum creatinine	Measured before surgery
Total cholesterol	Measured before surgery
Triglyceride	Measured before surgery
LDL	Measured before surgery
HDL	Measured before surgery
Hemoglobin	Measured before surgery
High-sensitivity C-reactive protein (hsCRP)	Measured before surgery
Erythrocyte sedimentation rate (ESR)	Measured before surgery
Left carotid artery lesion	Diagnosed using US or arteriography
Right carotid artery lesion	Diagnosed using US or arteriography
Left renal artery stenosis	Diagnosed using US or arteriography
Right renal artery stenosis	Diagnosed using US or arteriography
Number of involved coronary arteries	Diagnosed using arteriography
Left main stenosis	≥50%
Left descending stenosis	≥50%
Circumflex stenosis	≥50%
Right coronary stenosis	≥50%
Graft stenosis	For patients with previous CABG
Ejection fraction	Assessed by echocardiography (measured before surgery)
Ventricular aneurysm	Diagnosed using by UCG
Pulmonary hypertension	Systolic PA pressure>β60 mmHg
Valve stenosis or insufficiency	Either valve
Aortic stenosis	Diagnosed using UCG
Mitral stenosis	Diagnosed using by UCG
Tricuspid stenosis	Diagnosed using UCG
Pulmonary stenosis	Diagnosed using UCG
Aortic insufficiency	Diagnosed using UCG
Mitral insufficiency	Diagnosed using UCG
Tricuspid insufficiency	Diagnosed using UCG
Pulmonary insufficiency	Diagnosed using UCG

Tab.1 Table 1 Sixty-seven preoperative risk factors for univariate analysis (Part 1/2)

Variable	Definition
Non-elective surgery	Excludes emergency or salvage surgery. Emergency is defined as unscheduled surgery required on the same day because of refractory angina despite maximal medical therapy, acute evolving myocardial infarction within 24βh before surgery, aortic dissection, PCI failure, or other reasons. Salvage surgery is for patients who had cardiopulmonary resuscitation before arrival in the anesthetic room.
On-pump surgery	With extracorporeal circulation
Time of extracorporeal circulation	In minutes
Time of aortic clamp	In minutes
Beating heart surgery	Considered as “beating” for on-pump surgery with ventricular fibrillation
Site of cannula	For on-pump patients
Aortic clamp	Including no clamp, partial clamp, and complete clamp
Intra-aortic balloon pump (IABP) support during or after CABG	Not including preoperative IABP
Ventricular assist device (VAD)	With the aid of ventricular assistance device
Heart transplantation	Heart transplant
Extracorporeal membrane oxygenation (ECMO)	With the aid of ECMO
Number of grafts	Including arterial and venous grafts
Combined valve surgery	Surgical procedures with either valve
Procedure on aortic valve	Including repair, replacement, and any other procedures
Procedure on mitral valve	Including repair, replacement, and any other procedures
Procedure on tricuspid valve	Including repair, replacement, and any other procedures
Procedure on pulmonary valve	Including repair, replacement, and any other procedures
Repair for ventricular aneurysm	Including any kind of repair
Repair of septal rupture	Repair of septal rupture
Excision of heart tumor	Excision of heart tumor
Repair of congenital heart defects	Including VSD/ASD repair and others
Laser drilling	Laser drilling
Repair of injured cardiac muscle	Procedure for the repair of injured heart muscle
Implantation of permanent pacemaker	Implantation of permanent pacemaker
Surgery for atrial fibrillation	Including Maze procedure or other radio frequency ablation
Thoracic aorta procedure	For disorders of the ascending, arch, or descending aorta
Cell transplantation	Via coronary injection or direct injection
Hybrid procedure	Planned hybrid procedure with PCI and CABG
Carotid procedure	Including stent implantation and CEA
Post-infarct septal rupture

Tab.2 Table 1 Thirty operative risk factors for univariate analysis (Part 2/2)

Tab.3 Table 2 Risk factors and weights

Tab.4 Table 3 Statistical features of datasets in SinoSCORE

Fig.1 (A) ROC curve for SinoSCORE in the developmental dataset; (B) ROC curve for SinoSCORE in the validation dataset.

Tab.5 Table 4 Application of SinoSCORE

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