Advertisement
Original Article| Volume 61, ISSUE 7, P663-670, July 2008

Download started.

Ok

The EuroSCORE and a local model consistently predicted coronary surgery mortality and showed complementary properties

  • Aida Ribera
    Affiliations
    CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain

    Epidemiology Unit, Cardiology Department, University Hospital Vall d'Hebron, Barcelona, Spain

    Department of Health and Experimental Sciences, Universitat Pompeu Fabra, Barcelona, Spain
    Search for articles by this author
  • Ignacio Ferreira-Gonzalez
    Affiliations
    Epidemiology Unit, Cardiology Department, University Hospital Vall d'Hebron, Barcelona, Spain
    Search for articles by this author
  • Purificació Cascant
    Affiliations
    CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain

    Epidemiology Unit, Cardiology Department, University Hospital Vall d'Hebron, Barcelona, Spain
    Search for articles by this author
  • Joan M.V. Pons
    Affiliations
    CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain

    Catalan Agency for Health Technology Assessment, Barcelona, Spain
    Search for articles by this author
  • Gaietà Permanyer-Miralda
    Correspondence
    Corresponding author: Tel.: +00-34-932746177; fax: +00-34-932746063.
    Affiliations
    CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain

    Epidemiology Unit, Cardiology Department, University Hospital Vall d'Hebron, Barcelona, Spain
    Search for articles by this author
  • for the ARCA Study group investigators
    Author Footnotes
    1 Marcos Murtra (Department of Cardiac Surgery, University Hospital Vall d'Hebron, Barcelona, Spain); Carlos Sureda, Miguel Ángel Castro, and Xavier Ruyra (Department of Cardiac Surgery, Hospital Germans Trias i Pujol, Barcelona, Spain); Bernat Romero, Francisco Callejo, and Alejandro Arís (Hospital de la Santa Creu i de Sant Pau, Barcelona, Spain); Carmen Martínez-Useros and Jaume Mulet (Hospital General de Catalunya, Barcelona, Spain); Mireia Sanz and Oriol Solé (Centre Cardiovascular Sant Jordi, Barcelona, Spain).
  • Author Footnotes
    1 Marcos Murtra (Department of Cardiac Surgery, University Hospital Vall d'Hebron, Barcelona, Spain); Carlos Sureda, Miguel Ángel Castro, and Xavier Ruyra (Department of Cardiac Surgery, Hospital Germans Trias i Pujol, Barcelona, Spain); Bernat Romero, Francisco Callejo, and Alejandro Arís (Hospital de la Santa Creu i de Sant Pau, Barcelona, Spain); Carmen Martínez-Useros and Jaume Mulet (Hospital General de Catalunya, Barcelona, Spain); Mireia Sanz and Oriol Solé (Centre Cardiovascular Sant Jordi, Barcelona, Spain).

      Abstract

      Objective

      To revalidate a local model for prediction of in-hospital mortality after coronary surgery several years after its introduction and the EuroSCORE in a specific area within its original scope. To assess the specific advantages of one type of instrument over the other in a definite context.

      Study Design and Setting

      Data from consecutive patients undergoing a first isolated coronary artery bypass between November 2001 and November 2003 in five hospitals in Catalonia were prospectively collected.

      Results

      The study included 1,605 patients. Areas under the receiver-operating characteristics curves were around 0.75 for both models. Calibration was low for both models and the local model significantly overestimated risk. The ordering of operating centers by performance was identical with each strategy but the centers labeled as outliers differed.

      Conclusion

      (1) Evaluation of performance of individual hospitals was consistent using both systems and almost identical when they were internally recalibrated, (2) The impact of the benchmark population characteristics on model performance may be greater than that of risk factors considered for score calculation, (3) Promoting the use of a widely used instrument as the EuroSCORE might be sufficient for most evaluations. Local scales can be useful to highlight locally relevant features and temporal trends.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Clinical Epidemiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Pitkänen O.
        • Niskanen M.
        • Rehnberg S.
        • Hippeläinen M.
        • Hynynen M.
        Intra-institutional prediction of outcome after cardiac surgery: comparison between a locally derived model and the EuroSCORE.
        Eur J Cardio-thorac Surg. 2000; 18: 703-710
        • Kizer J.R.
        • Beerlin J.A.
        • Laskey W.K.
        • Sanford Schwartz J.
        • Sauer W.H.
        • Krone R.J.
        • Kimmel S.E.
        Limitations of current risk-adjustment models in the era of coronary stenting.
        Am Heart J. 2003; 145: 683-692
        • Nashef S.A.M.
        • Roques F.
        • Michel P.
        • Gauducheau E.
        • Lemeshow S.
        • Salomon R.
        • the EuroSCORE study group
        European system for cardiac operative risk evaluation (EuroSCORE).
        Eur J Cardio-thorac Surg. 1999; 16: 9-13
        • Roques F.
        • Nashef S.A.M.
        • Pinna Pintor P.
        • David M.
        • Baudet E.
        Does EuroSCORE work in individual European countries?.
        Eur J Cardio-thorac Surg. 2000; 18: 27-30
        • Pons J.M.V.
        • Granados A.
        • Espinas J.A.
        • Borras J.M.
        • Martin I.
        • Moreno V.
        Assessing open heart surgery mortality in Catalonia (Spain) through a predictive risk model.
        Eur J Cardio-thorac Surg. 1997; 11: 415-423
        • Roques F.
        • Michel P.
        • Goldstone A.R.
        • Nashef S.A.M.
        The logistic EuroSCORE.
        Eur Heart J. 2003; 24: 1-2
        • DeLong E.R.
        • DeLong D.M.
        • Clarke-Pearson D.L.
        Comparing areas under two or more correlated receiver operating curves: a nonparametric approach.
        Biometrics. 1988; 44: 837-845
        • DeLong E.R.
        • Peterson E.D.
        • DeLong D.M.
        • Muhlbaier L.H.
        • Hackett S.
        • Mark D.B.
        Comparing risk-adjustment methods for provider profiling.
        Stat Med. 1997; 16: 2645-2664
        • Steyerberg E.W.
        • Eijkemans M.J.C.
        • Boersma E.
        • Habbema J.D.F.
        Equally valid models gave divergent predictions for mortality in acute myocardial infarction patients in a comparison of logical regression models.
        J Clin Epidemiol. 2005; 58: 383-390
        • Hamley J.
        McNeil B.J. The meaning and use of the area under receiver operating characteristic (ROC) curve. Radiology. 143. 1992: 29-36
        • Ivanov J.
        • Tu J.V.
        • Naylor C.D.
        Ready-made, recalibrated, or remodeled? Issues in the use of risk indexes for assessing mortality after coronary artery bypass graft surgery.
        Circulation. 1999; 99: 2098-2104
        • Peterson E.D.
        • DeLong E.R.
        • Muhlbaier L.H.
        • Rosen A.B.
        • Buell H.E.
        • Kiefe C.I.
        • et al.
        Challenges in comparing risk-adjusted bypass surgery mortality results.
        JACC. 2000; 36: 2174-2184
        • Hannan E.L.
        • Wu C.
        Assessing quality and outcomes for percutaneous coronary intervention: choosing statistical models, outcomes, time periods, and patient populations.
        Am Heart J. 2003; 145: 571-574
        • García-Fuster R.
        • Montero J.A.
        • Gil O.
        • Hornero F.
        • Cánovas S.
        • Bueno M.
        • et al.
        Trends in coronary artery bypass surgery: changing type of surgical patient.
        Rev Esp Cardiol. 2005; 58: 512-522
        • Pons J.M.V.
        • Moreno V.
        • Borras J.
        • Espinas J.
        • Almazan C.
        • Granados A.
        Open heart surgery in public and private practice.
        J Health Serv Res Policy. 1999; 4: 73-78
        • Permanyer-Miralda G.
        • Brotons C.
        • Ribera A.
        • Alonso J.
        • Cascant P.
        Moral I and the CIRCORCA study group. Outcomes of coronary artery surgery: determinants of quality of live related to postoperative health.
        Rev Esp Cardiol. 2001; 54: 607-616
        • Pons J.M.V.
        • Borras J.M.
        • Espinas J.A.
        • Moreno V.
        • Cardona M.
        • Granados A.
        Subjective versus statistical assessment of mortality risk in open heart surgical procedures.
        Ann thorac Surg. 1999; 67: 635-640
        • Grover F.L.
        • Shroyer A.L.
        • Hammermeister K.
        • Edwards F.H.
        • Ferguson T.B.
        • Dziuban S.W.
        • et al.
        A decade's experience with quality improvement in cardiac surgery using the Veterans Affairs and Society of Thoracic Surgeons national databases.
        Ann Surg. 2001; 234: 464-472
        • Shahian D.M.
        • Blackstone E.H.
        • Edwards F.H.
        • Grover F.L.
        • Grunkemeier G.L.
        • Naftel D.C.
        • et al.
        • STS workforce on evidence-based surgery
        Cardiac surgery risk models: a position article.
        Ann Thorac Surg. 2004; 78: 1868-1877