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Eur J Cardiothorac Surg 2001 Nov;20(5):961-6
(Full
text access)
Risk stratification analysis of operative mortality in heart
and thoracic aorta surgery: comparison between Parsonnet and EuroSCORE additive
model.
Kawachi Y, Nakashima A, Toshima Y, Arinaga K, Kawano H.
Cardiovascular Surgery, Clinical Research Institute, National Kyushu Medical
Center Hospital, 1-8-1 Jigyo-hama, Chuo-ku, 810-8563, Fukuoka, Japan
Objective: Our purpose was to compare the performance of risk stratification
model between Parsonnet and European System for Cardiac Operative Risk
Evaluation (EuroSCORE) in our patient database. Methods: From August 1994 to
December 2000, 803 consecutive patients have undergone heart and thoracic aorta
surgery using cardiopulmonary bypass and scored according to Parsonnet and
EuroSCORE algorithm. The population was divided into five clinically relevant
risk categories. We compared correlation of predicted mortality and observed
mortality between these two models. Score validity was assessed by calculating
the area under the receiver operating characteristic (ROC) curve. Results:
Overall hospital mortality was 4.5%. In Parsonnet model, predicted mortality was
2.4% for 0-4% risk, 6.7% for 5-9% risk, 12% for 10-14% risk, 17% for 15-19%
risk, 25% for 20% plus risk, and 10.4% for overall patients. Observed mortality
was 2.4, 0.4, 5.9, 8.7, 11, and 4.5%, respectively. The thoracic aorta and valve
cohort indicated poor correlation between predicted and observed mortality
compared to coronary cohort. In the EuroSCORE model, predicted mortality was
1.4% for 0-2% risk, 4.0% for 3-5% risk, 6.7% for 6-8% risk, 9.7% for 9-11% risk,
13% for 12% plus risk, and 5.3% for overall patients. Actual mortality was 0,
1.5, 6.8, 11, 21, and 4.5%, respectively. Each of the thoracic aorta, valve, and
coronary cohort indicated good correlation between predicted and observed
mortality. Areas under the ROC curves were 0.72 in Parsonnet and 0.82 in
EuroSCORE. Conclusions: The EuroSCORE additive model yielded good predictive
value for hospital mortality of Japanese patients undergoing not only cardiac
but also thoracic aortic surgery.
