title: The society of thoracic surgeons 30-day predicted risk of mortality score also predicts long-term survival.
abstract: BACKGROUND
  The Society of Thoracic Surgeons Predicted Risk of Mortality (PROM) score is a well-validated predictor of 30-day mortality after cardiac procedures. This study investigated the ability of PROM to predict longer-term survival.
  
  
  METHODS
  From January 1, 1996, to December 31, 2009, 24,222 patients with PROM scores underwent cardiac procedures at an academic center. Long-term all-cause mortality was determined from the Social Security Death Index. Logistic and Cox survival regression analyses evaluated the long-term predictive utility of the PROM. Area under the receiver operator characteristic curve measured the discrimination of PROM at 1, 3, 5, and 10 years. Kaplan-Meier curves were stratified by quartiles of PROM risk to compare long-term survival. All analyses were performed for the whole sample and for 30-day survivors.
  
  
  RESULTS
  The overall 30-day mortality was 2.78% (674 of 24,222). PROM predicted 30-day mortality extremely well (area under the receiver operator characteristic, 0.794) and predicted longer-term survival almost as well. Among all patients and 30-day survivors, area under the receiver operator characteristic values for PROM at 1, 3, 5, and 10 years were remarkably similar to the 30-day end point for which PROM is calibrated. PROM was highly predictive of Kaplan-Meier survival for patients surviving beyond 30 days. Among 30-day survivors, each percent increase in PROM score was associated with a 9.6% increase (95% confidence interval, 9.3% to 10.0%) in instantaneous hazard of death (p<0.001).
  
  
  CONCLUSIONS
  The PROM algorithm accurately predicts death at 30-days and during 14 years of follow-up with almost equally strong discriminatory power. This may have profound implications for informed consent and for longitudinal comparative effectiveness studies.
authors: Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia 30308, USA. john.puskas@emoryhealthcare.org
authors: John D
authors: JD
authors: Puskas
authors: Patrick D
authors: PD
authors: Kilgo
authors: Vinod H
authors: VH
authors: Thourani
authors: Omar M
authors: OM
authors: Lattouf
authors: Edward
authors: E
authors: Chen
authors: J David
authors: JD
authors: Vega
authors: William
authors: W
authors: Cooper
authors: Robert A
authors: RA
authors: Guyton
authors: Michael
authors: M
authors: Halkos
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005845:Georgia / Q000453:epidemiology; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012955:Societies, Medical; D015996:Survival Rate / Q000639:trends; D013903:Thoracic Surgery; D019616:Thoracic Surgical Procedures / Q000401:mortality*; D013997:Time Factors