title: The first Latin-American risk stratification system for cardiac surgery: can be used as a graphic pocket-card score.
abstract: This study aims to develop the first Latin-American risk model that can be used as a simple, pocket-card graphic score at bedside. The risk model was developed on 2903 patients who underwent cardiac surgery at the Spanish Hospital of Buenos Aires, Argentina, between June 1994 and December 1999. Internal validation was performed on 708 patients between January 2000 and June 2001 at the same center. External validation was performed on 1087 patients between February 2000 and January 2007 at three other centers in Argentina. In the development dataset the area under receiver operating characteristics (ROC) curve was 0.73 and the Hosmer-Lemeshow (HL) test was P=0.88. In the internal validation ROC curve was 0.77. In the external validation ROC curve was 0.81, but imperfect calibration was detected because the observed in-hospital mortality (3.96%) was significantly lower than the development dataset (8.20%) (P<0.0001). Recalibration was done in 2007, showing excellent level of agreement between the observed and predicted mortality rates on all patients (P=0.92). This is the first risk model for cardiac surgery developed in a population of Latin-America with both internal and external validation. A simple graphic pocket-card score allows an easy bedside application with acceptable statistic precision.
authors.affiliation: Instituto de Cardiología, Hospital Español de Buenos Aires, Ciudad Autónoma de Buenos Aires, C1209AQK Buenos Aires, Argentina. drcarosella@yahoo.com
authors.forename: Victorio C
authors.initials: VC
authors.lastname: Carosella
authors.forename: Jose L
authors.initials: JL
authors.lastname: Navia
authors.forename: Sharif
authors.initials: S
authors.lastname: Al-Ruzzeh
authors.forename: Hugo
authors.initials: H
authors.lastname: Grancelli
authors.forename: Walter
authors.initials: W
authors.lastname: Rodriguez
authors.forename: Cesar
authors.initials: C
authors.lastname: Cardenas
authors.forename: Jorge
authors.initials: J
authors.lastname: Bilbao
authors.forename: Carlos
authors.initials: C
authors.lastname: Nojek
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044467:American Indian or Alaska Native / Q000706:statistics & numerical data*; D001118:Argentina / Q000453:epidemiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006305:Health Status Indicators; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors