title: Comparison of 19 pre-operative risk stratification models in open-heart surgery.
abstract: OBJECTIVE
  To compare 19 risk score algorithms with regard to their validity to predict 30-day and 1-year mortality after cardiac surgery.
  
  
  RESULTS
  Risk factors for patients undergoing heart surgery between 1996 and 2001 at a single centre were prospectively collected. Receiver operating characteristics (ROC) curves were used to describe the performance and accuracy. Survival at 1 year and cause of death were obtained in all cases. The study included 6222 cardiac surgical procedures. Actual mortality was 2.9% at 30 days and 6.1% at 1 year. Discriminatory power for 30-day and 1-year mortality in cardiac surgery was highest for logistic (0.84 and 0.77) and additive (0.84 and 0.77) European System for Cardiac Operative Risk Evaluation (EuroSCORE) algorithms, followed by Cleveland Clinic (0.82 and 0.76) and Magovern (0.82 and 0.76) scoring systems. None of the other 15 risk algorithms had a significantly better discriminatory power than these four. In coronary artery bypass grafting (CABG)-only surgery, EuroSCORE followed by New York State (NYS) and Cleveland Clinic risk score showed the highest discriminatory power for 30-day and 1-year mortality.
  
  
  CONCLUSIONS
  EuroSCORE, Cleveland Clinic, and Magovern risk algorithms showed superior performance and accuracy in open-heart surgery, and EuroSCORE, NYS, and Cleveland Clinic in CABG-only surgery. Although the models were originally designed to predict early mortality, the 1-year mortality prediction was also reasonably accurate.
authors.affiliation: Department of Cardiothoracic Surgery, Heart and Lung Centre, Lund University Hospital, Sweden. johan.nilsson@thorax.lu.se
authors.forename: Johan
authors.initials: J
authors.lastname: Nilsson
authors.forename: Lars
authors.initials: L
authors.lastname: Algotsson
authors.forename: Peter
authors.initials: P
authors.lastname: Höglund
authors.forename: Carsten
authors.initials: C
authors.lastname: Lührs
authors.forename: Johan
authors.initials: J
authors.lastname: Brandt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D005260:Female; D006331:Heart Diseases / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment / Q000592:standards; D012307:Risk Factors