Skip to main content

Advertisement

SpringerLink
Log in

Comparison of European System for Cardiac Operative Risk Evaluation (EuroSCORE) and the Society of Thoracic Surgeons(STS) score for risk prediction in Indian patients undergoing coronary artery bypass grafting

  • Original Article
  • Published:
Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Background

For risk stratifying patients undergoing coronary artery bypass graft (CABG), the Society of Thoracic Surgeons (STS) risk score and the European System for Cardiac Operative Risk Evaluation (EuroSCORE) are currently used. However, the superiority of one over the other in the context of Indian patients has not been assessed. The aim of this study was to compare these 2 scoring systems in Indian patients undergoing CABG.

Methodology

This was a retrospective analysis of prospectively collected data between January 2015 and September 2020 of all patients undergoing CABG. Observed mortality in the cohort was compared with the predicted mortality using the STS and the EuroSCORE II. Sensitivity and specificity were calculated for both the scores. Receiver operating characteristic (ROC) curves were constructed for both the STS and the EuroSCORE II and area under the ROC curve (AUC) was calculated.

Results

A total of 4895 patients were included in the study. The overall observed mortality in the entire cohort was 74 (1.5%). The EuroSCORE II–predicted mortality was 1.9 ± 2.5 whereas the STS score–predicted mortality was 1.2 ± 1.8. The observed to predicted mortality ratio for EuroSCORE was 0.79 and 1.25 for the STS score. The discriminative ability for operative mortality of the STS score was 0.72 (0.71 to 0.74) and 0.713 for the EuroSCORE, suggesting satisfactory discriminatory power. There was no difference between the STS score and the EuroSCORE in terms of discriminatory power (p = 0.58) and a difference in the AUC being 0.01. The discriminatory power of the EuroSCORE and the STS score was best in the high-risk category.

Conclusions

Both the EuroSCORE and the STS scores had satisfactory and similar discriminatory power. However, in the Indian population, while the EuroSCORE II overestimated mortality, the STS score underestimated it to a similar degree of error.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Krishna N, Varma PK. Risk stratification in cardiac surgery. Indian J Thorac Cardiovasc Surg. 2015;31:224–33.

    Article  Google Scholar 

  2. Nashef SA, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg. 1999;16:9–13.

    Article  CAS  Google Scholar 

  3. Hattler BG, Madia C, Johnson C, et al. Risk stratification using the Society of Thoracic Surgeons program. Ann Thorac Surg. 1994;58:1348–52.

    Article  CAS  Google Scholar 

  4. Nashef SAM, Roques F, Sharples LD, et al. EuroSCORE II. Eur J Cardiothorac Surg. 2012;41:734–44.

    Article  Google Scholar 

  5. Shahian DM, Jacobs JP, Badhwar V, et al. The Society of Thoracic Surgeons 2018 adult cardiac surgery risk models: part 1-background, design considerations, and model development. Ann Thorac Surg. 2018;105:1411–8.

    Article  Google Scholar 

  6. Kar P, Geeta K, Gopinath R, Durga P. Mortality prediction in Indian cardiac surgery patients: validation of European system for cardiac operative risk evaluation II. Indian J Anaesth. 2017;61:157–62.

    Article  Google Scholar 

  7. Borde D, Gandhe U, Hargave N, Pandey K, Khullar V. The application of European system for cardiac operative risk evaluation II (EuroSCORE II) and Society of Thoracic Surgeons (STS) risk-score for risk stratification in Indian patients undergoing cardiac surgery. Ann Card Anaesth. 2013;16:163–6.

    Article  Google Scholar 

  8. Pillai BS, Baloria KA, Selot N. Validation of the European system for cardiac operative risk evaluation-II model in an urban Indian population and comparison with three other risk scoring systems. Ann Card Anaesth. 2015;18:335–42.

    Article  Google Scholar 

  9. Borde D, Asegaonkar B, Apsingekar P, et al. Risk stratification in off-pump coronary artery bypass (OPCAB) surgery—role of EuroSCORE II. J Cardiothorac Vasc Anesth. 2015;29:1167–71.

    Article  Google Scholar 

  10. Malik M, Chauhan S, Malik V, Gharde P, Kiran U, Pandey RM. Is EuroSCORE applicable to Indian patients undergoing cardiac surgery? Ann Card Anaesth. 2010;13:241–5.

    Article  Google Scholar 

  11. 1_3kOQSTg.pdf. [cited 2020 Dec 31]. Available from: http://resource.heartonline.cn/20150528/1_3kOQSTg.pdf

  12. Higgins TL. Quantifying risk and assessing outcome in cardiac surgery. J Cardiothorac Vasc Anesth. 1998;12:330–40.

    Article  CAS  Google Scholar 

  13. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143:29–36.

    Article  CAS  Google Scholar 

  14. Risk stratification of in-hospital mortality for coronary artery bypass graft surgery - PubMed. [cited 2020 Dec 31]. Available from: https://pubmed.ncbi.nlm.nih.gov/16458152/

  15. Nattino G, Pennell ML, Lemeshow S. Assessing the goodness of fit of logistic regression models in large samples: a modification of the Hosmer-Lemeshow test. Biometrics. 2020;76:549–60.

    Article  Google Scholar 

  16. Ad N, Holmes SD, Patel J, Pritchard G, Shuman DJ, Halpin L. Comparison of EuroSCORE II, original EuroSCORE, and the Society of Thoracic Surgeons risk score in cardiac surgery patients. Ann Thorac Surg. 2016;102:573–9.

    Article  Google Scholar 

  17. Ranjan R, Adhikary D, Mandal S, Saha SK, Hasan K, Adhikary AB. Performance of EuroSCORE II and logistic EuroSCORE in Bangladeshi population undergoing off-pump coronary artery bypass surgery: a prospective cohort study. JRSM Cardiovasc Dis. 2019;8:2048004019862125.

    PubMed  PubMed Central  Google Scholar 

  18. Brieger DB, Ng ACC, Chow V, et al. Falling hospital and postdischarge mortality following CABG in New South Wales from 2000 to 2013. Open Heart. 2019;6:e000959.

    Article  Google Scholar 

  19. Jin R, Furnary AP, Fine SC, Blackstone EH, Grunkemeier GL. Using Society of Thoracic Surgeons risk models for risk-adjusting cardiac surgery results. Ann Thorac Surg. 2010;89:677–82.

    Article  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, 700099, India

    Sufina Shales, Sukamanchi Uma Maheswara Rao, Swanand Khapli, Paramita Auddya Ghorai, Sukanta Kumar Behera, Arup Kumar Ghosh & Pradeep Narayan

Authors
  1. Sufina Shales
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sukamanchi Uma Maheswara Rao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Swanand Khapli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paramita Auddya Ghorai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sukanta Kumar Behera
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Arup Kumar Ghosh
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Pradeep Narayan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pradeep Narayan.

Ethics declarations

Informed consent

This being a retrospective study, the need for informed consent was waived off by the ethics committee.

Ethical approval

Ethical approval was obtained from the institutional ethics committee (NHRTIICSEC/AP/2021/001) on the 4th January 2021.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shales, S., Uma Maheswara Rao, S., Khapli, S. et al. Comparison of European System for Cardiac Operative Risk Evaluation (EuroSCORE) and the Society of Thoracic Surgeons(STS) score for risk prediction in Indian patients undergoing coronary artery bypass grafting. Indian J Thorac Cardiovasc Surg 37, 623–630 (2021). https://doi.org/10.1007/s12055-021-01186-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12055-021-01186-1

Keywords

Search

Navigation