title: InsCor: a simple and accurate method for risk assessment in heart surgery.
abstract: BACKGROUND
  Risk scores show difficulties to attain the same performance in different populations.
  
  
  OBJECTIVE
  To create a simple and accurate risk assessment model for patients submitted to surgery due to coronary and/or valvular disease at Instituto do Coração da Universidade de São Paulo (InCor-HCFMUSP).
  
  
  METHODS
  Between 2007 and 2009, 3,000 patients were submitted to surgical procedure due to coronary artery and/or valvular disease at InCor-HCFMUSP. From this record, data of 2/3 of the patients were used for model development (bootstrap technique), and 1/3 for internal validation of the model. The performance of the model (InsCor) was compared to the 2000 Bernstein-Parsonnet (2000BP) and EuroSCORE (ES) complexes.
  
  
  RESULTS
  Only 10 variables were selected: age > 70 years, female sex; coronary revascularization + valve, myocardial infarction < 90 days; reoperation; surgical treatment of aortic valve; surgical treatment of tricuspid valve; creatinine < 2mg/dL; ejection fraction < 30%, and events. The Hosmer Lemeshow test for the InsCor was 0.184, indicating excellent calibration. The area under the ROC curve was 0.79 for the InsCor, 0.81 for the ES and 0.82 for 2000BP, confirming that the models are good and have similar discrimination.
  
  
  CONCLUSIONS
  The InsCor and ES performed better than 2000BP at all stages of validation, but the new model, in addition to showing identification with the local risk factors, is simpler and more objective for mortality prediction in patients undergoing surgery due to coronary and/or valvular disease at InCor-HCFMUSP.
authors.affiliation: Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade da São Paulo, São Paulo, SP, Brazil. omarvmejia@sbccv.org.br
authors.forename: Omar A V
authors.initials: OA
authors.lastname: Mejía
authors.forename: Luiz A F
authors.initials: LA
authors.lastname: Lisboa
authors.forename: Luiz B
authors.initials: LB
authors.lastname: Puig
authors.forename: Luiz Felipe P
authors.initials: LF
authors.lastname: Moreira
authors.forename: Luis A O
authors.initials: LA
authors.lastname: Dallan
authors.forename: Pablo M A
authors.initials: PM
authors.lastname: Pomerantzeff
authors.forename: Fabio B
authors.initials: FB
authors.lastname: Jatene
authors.forename: Noedir A G
authors.initials: NA
authors.lastname: Stolf
mesh_terms: D000368:Aged; D002138:Calibration / Q000592:standards; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D015233:Models, Statistical; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods / Q000592:standards