Enhanced Assessment of Perioperative Mortality Risk in Adults With Congenital Heart Disease
| Autor: | Konstantinos Dimopoulos, Isma Rafiq, Andrew Constantine, Giulia Costola, Andreas Hoschtitzky, Aleksander Kempny, Massimo Chessa, Darryl F. Shore, TC Aw, Alessandro Giamberti, Paolo Bianchi, Marco Ranucci, Michael A. Gatzoulis, Sonya V. Babu-Narayan |
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| Přispěvatelé: | British Heart Foundation, Constantine, A., Costola, G., Bianchi, P., Chessa, M., Giamberti, A., Kempny, A., Rafiq, I., Babu-Narayan, S. V., Gatzoulis, M. A., Hoschtitzky, A., Shore, D., Aw, T. -C., Ranucci, M., Dimopoulos, K. |
| Rok vydání: | 2021 |
| Předmět: |
Adult
Heart Defects Congenital Male medicine.medical_specialty Heart disease Population risk score Risk Assessment 1117 Public Health and Health Services Risk Factors Internal medicine Medicine Humans Hospital Mortality Cardiac Surgical Procedures education clinical risk tool 1102 Cardiorespiratory Medicine and Haematology perioperative risk Retrospective Studies education.field_of_study Framingham Risk Score business.industry Perioperative medicine.disease congenital heart disease United Kingdom Cardiac surgery Survival Rate Cardiovascular System & Hematology ROC Curve Cohort Female Cardiology and Cardiovascular Medicine Complication business Risk assessment Follow-Up Studies |
| Zdroj: | Journal of the American College of Cardiology. 78(3) |
| ISSN: | 1558-3597 |
| Popis: | Background In-hospital mortality is a rare, yet feared complication following cardiac surgery in adult congenital heart disease (ACHD). A risk score, developed and validated in ACHD, can be helpful to optimize risk assessment. Objectives To assess the performance of EuroSCORE II components and procedure-related Adult Congenital Heart Surgery (ACHS) score, identify additional risk factors, and develop a novel risk score for predicting in-hospital mortality after ACHD surgery. Methods We assessed perioperative survival in patients >16 years undergoing congenital heart surgery in a large tertiary center between 2003 and 2019. A risk variable derived PErioperative ACHd (PEACH) score was calculated for each patient. Internal and external validation of the model was undertaken, including testing in a validation cohort of patients operated in a second European ACHD center. Results The development cohort comprised 1782 procedures performed during the study period. Re-sternotomy was undertaken in 897(50.3%). There were 31(1.7%) in-hospital deaths. The PErioperative ACHd (PEACH) score showed excellent discrimination ability (AUC 0.88, 95%CI:0.83-0.94), and performed better than the ACHS score in our population (ACHS AUC 0.69, 95%CI:0.6-0.78, p=0.0003). A simple 3-tiered risk stratification was formed: PEACH score 0 (in-hospital mortality 0.2%), 1-2 (3.6%), ≥3 (17.2%). In a validation cohort of 975 procedures, the PEACH score retained its discriminative ability (AUC 0.75, 95%CI:0.72-0.77) and was well calibrated (Hosmer Lemishow 2 goodness-of-fit p=0.55). There was agreement in expected and observed perioperative mortality between cohorts. Conclusions The PEACH score is a simple, novel peri-operative risk score developed and validated specifically for ACHD patients undergoing cardiac surgery. Condensed abstract: The PEACH score is a simple, novel peri-operative risk score developed and validated specifically for ACHD patients undergoing cardiac surgery. In this study, we assessed the performance of components of the existing EuroSCORE II and ACHS score in predicting in-hospital mortality after ACHD surgery and combined them with other predictors of peri-operative mortality into a single PErioperative ACHd (PEACH) score. This novel score showed good discrimination ability in both development (AUC 0.88, 95%CI:0.82-0.94) and external validation (ACHS score AUC 0.69, 95%CI:0.6-0.78, p=0.0003) cohorts, with good agreement between expected and observed perioperative mortality. |
| Databáze: | OpenAIRE |
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