Summary
This analysis examined the performance of two widely used cardiac surgery risk prediction models—the STS score and EuroSCORE-2—in patients with severely reduced left ventricular ejection fraction undergoing surgical revascularisation. Using data from the STICH trial (814 patients) and a contemporary cohort (1,246 patients), the authors found both models demonstrated moderately good discriminatory accuracy (C statistics 0.71–0.74), though the STS score tended to systematically underestimate mortality risk relative to EuroSCORE-2. Postoperative mortality rates declined between the two study periods despite higher baseline risk scores in the contemporary cohort.
UK applicability
These findings may inform cardiac surgery risk stratification and patient counselling practices in UK thoracic centres, particularly for high-risk patients with ischaemic cardiomyopathy. However, the contemporary cohort included predominantly European centres, so direct applicability to NHS populations would benefit from UK-specific validation studies.
Key measures
STS risk scores, EuroSCORE-2 scores, 30-day postoperative mortality rates, C statistics (area under the receiver operating characteristic curve)
Outcomes reported
The study evaluated the ability of the Society of Thoracic Surgeons (STS) risk score and EuroSCORE-2 to predict 30-day postoperative mortality in patients with left ventricular dysfunction (ejection fraction ≤35%) undergoing coronary artery bypass grafting. Mortality rates, risk score calculations, and discriminatory accuracy (C statistics) were measured across the STICH trial cohort and a contemporary cohort.
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