Analysis The Predictive Value In Early Mortality And Postoperative Complications In Patients Undergoing Coronary Artery Bypass Grafting In A Single Heart Center By Risk Scoring System

Objective:To access the predictive value in Postoperative mortality in patients undergoing coronary artery bypass grafting (CABG) by seven different Risk scoring system. To predict the early mortality and postoperative complication in patients undergoing coronary artery bypass grafting (CABG) by SinoSCORE in a single heart center,and access the performance of the SinoSCORE.Methods:To collect the clinical information of patients undergoing CABG in our department. SinoSCORE,Additive EuroSCORE,LogisticEuroSCORE,OPR,Cleveland model,Parsonnet score,QMMI were used to predict postoperative mortality for all patients,and calculate the mean predictive postoperative mortality.To devided the patients to six group:groupⅠ(0-1.99%),groupⅡ(2-3.99%), groupⅢ(4-5.99%) grouplV (6-7.99%), groupV(8-9.99%),groupVI(>10%) by predictive postoperative mortality.Access the performance of risk scoring system predict the mortality through compare the predictive mortality and the observed mortality in different Risk stratification.To use Hosmer-Lemeshow goodness-of-fit test access the calibration. Discrimination was tested by determining the area under the receiver operating characteristic(ROC) curve(AUC). To evaluate the performance of SinoSCORE on postoperative complications by AUC and Hosmer-Lemeshow test.The optimal cut-off point for SinoSCORE predicting major complications was obtained by the Yonden index. To used X2test to Compare incidence rate of postoperative complications in two group divided by cut-off point.Results:The overall mean baseline age was(62.8±8.8)years. The observed mortality in all our study patients was1.99%(22/1103). The predictive mortality calculated by SinoSCORE,Additive EuroSCORE,Logistic EuroSCORE,OPR,Cleveland model, Parsonnet score and QMMI were3.01%,4.38%,3.83%,1.69%,4.42%,6.71%and3.71%. And the most closest is OPR,SinoSCORE,QMMI. Group tests confirmed Logistic EuroSCORE Overestimated the mortality in all the group. Predicted mortality calculated by Additive EuroSCORE was lower than the actual mortality in groupV1(>10%)and higher than the observed mortality in other group. SinoSCORE、 Cleveland model、Parsonnet score、QMMI Overestimated the mortality in all the group expect group1(0-1.99%). OPR forecast a lower mortality Compared with observed mortality in groupⅠ(0-1.99%) and groupⅣ (6-7.99%) and a Slightly higher mortality in groupⅡ(2-3.99%), groupⅢ(4-5.99%).To use Hosmer-Lemeshow goodness-of-fit test access the calibration.The text proved all the risk scoring system had a good calibration for postoperative mortality(P>0.05). Discrimination was tested by ROC, only SinoSCORE (AUC=0.751>0.70) showed high discriminatory ability in predicting mortality. SinoSCORE also showed the good calibration power and vary high discriminatory ability for the main complication risk evaluation such as Low cardiac output syndrome, cerebrovascular events,tracheal incision,MODS and intraoperative/postoperative IABP implantation. Hosmer-Lemeshow:P=0.415, P=0.689, P=0.243, P=0.945, P=0.287. Areas under ROC curve was AUC=0.785, AUC=0.745, AUC=0.829, AUC=0.821, AUC=0.757. Obtained the optimal Cut-off points by calculating the Youden index. The optimal cut-off points for SinoSCORE model predicting early mortality and the above five major postoperative complication was3.5,6.5,5.5,3.5,3.5,5.5.We compared the>cut-off group and the<cut-off group for the main complications.There is no significant difference in MODS, so we excluded it.Conclusion:SinoSCOBE have a good forecast performance for the postoperative mortality in the patients undergoing CABG in our department in seven different Risk scoring system.And SinoSCORE could be used in preoperative risk assessment. SinoSCOBE also have a good forecast performance for some postoperative complication in the patients undergoing CABG in our department.And the postoperative complication include Low cardiac output syndrome,cerebrovascular events, tracheal incision and intraoperative/postoperative IABP implantation.