title: Reliability of new scores in predicting perioperative mortality after mitral valve surgery.
abstract: OBJECTIVE
  The study was designed to validate euroSCORE II and ACEF (age, creatinine, and ejection fraction) scores in patients undergoing isolated or associated mitral valve surgery and compare them with logistic euroSCORE and Society of Thoracic Surgeons scores.
  
  
  METHODS
  Data on 3441 consecutive patients undergoing isolated or associated mitral valve surgery in a 6-year period were retrieved from 3 prospective institutional databases. Discriminatory power was assessed with the C index. Calibration was evaluated with calibration curves and associated statistics.
  
  
  RESULTS
  In-hospital mortality was 3.4%. Discriminatory power was uniformly good (for euroSCORE II: area under curve, 0.79; 95% confidence interval, 0.74-0.84; for logistic euroSCORE: area under the curve, 0.78; 95% confidence interval, 0.74-0.83; for ACEF: area under the curve, 0.73; 95% confidence interval, 0.69-0.79) but significantly higher in euroSCORE models (P < .05 for Delong, bootstrap, Venkatraman methods). Calibration pattern was slightly better for the ACEF score, although related summary statistics (unreliability, Hosmer-Lemeshow test, Spiegelhalter z-test for calibration accuracy) were not significant even for euroSCORE II. The euroSCORE II demonstrated a performance similar to Society of Thoracic Surgeons score. Logistic euroSCORE confirmed the progressive trend toward overprediction previously demonstrated in the general cardiac surgical population (summary statistics P < .05). Analysis of score performances in the surgical group studied showed results comparable to the global population.
  
  
  CONCLUSIONS
  The euroSCORE II and ACEF scores are good predictors of perioperative mortality in patients undergoing isolated or associated mitral valve surgery, with better discrimination for the first and better calibration for the second. No algorithm seems suitable for risk estimation in mid and high-risk patients.
authors.affiliation: Department of Cardiac Surgery, S Croce Hospital, Cuneo, Italy. Electronic address: fabarili@libero.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Barili
authors.affiliation: Department of Cardiac Surgery, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Pacini
authors.affiliation: Department of Cardiac Surgery, S Croce Hospital, Cuneo, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Grossi
authors.affiliation: Department of Cardiac Surgery, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Bartolomeo
authors.affiliation: Department of Cardiovascular Sciences, University of Milan, Centro Cardiologico Monzino IRCCS, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Alamanni
authors.affiliation: Department of Cardiovascular Sciences, University of Milan, Centro Cardiologico Monzino IRCCS, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Parolari
mesh_terms: D000367:Age Factors; D000368:Aged; D000465:Algorithms; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood; D003661:Decision Support Techniques; D016002:Discriminant Analysis; D005260:Female; D006349:Heart Valve Diseases / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D018579:Patient Selection; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D003404:Creatinine