Performance of scoring systems for predicting mortality after cardiacsurgery in the elderly

Arturo M. Ruiz-Beltrán; Gerardo Chacón-Loyola; Ricardo L. Barajas-Campos; Alejandro Alcaraz-Guzmán; Manuel A. Montoya-Hernández; Leonardo D. Alcázar-Flores; Laura L. Rodríguez-Chávez

doi:10.47487/apcyccv.v6i1.459

Autores/as

Arturo M. Ruiz-Beltrán Division of Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico city, Mexico. https://orcid.org/0000-0001-9958-1340
Gerardo Chacón-Loyola Division of Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico city, Mexico. https://orcid.org/0000-0003-2083-0557
Ricardo L. Barajas-Campos Division of Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico city, Mexico. https://orcid.org/0000-0002-9663-1311
Alejandro Alcaraz-Guzmán Division of Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico city, Mexico. https://orcid.org/0009-0007-0244-1407
Manuel A. Montoya-Hernández Division of Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico city, Mexico. https://orcid.org/0000-0003-0380-3119
Leonardo D. Alcázar-Flores Division of Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico city, Mexico. https://orcid.org/0009-0007-5156-3267
Laura L. Rodríguez-Chávez Division of Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico city, Mexico. https://orcid.org/0000-0003-1162-9018

DOI:

https://doi.org/10.47487/apcyccv.v6i1.459

Palabras clave:

Cardiac Surgical Procedures, Risk, Aged, Frail Elderly

Resumen

Objective. To evaluate the predictive ability of traditional risk scores and frailty assessment for 30-day mortality in elderly patients undergoing cardiac surgery. Materials and Methods. A single-center retrospective cohort study was conducted, including elderly patients (≥75 years old) who underwent cardiac surgery between January 2005 and December 2015. EuroSCORE II, STS (Society of Thoracic Surgeons) score, Charlson Comorbidity Index, and Electronic Frailty Index scores were calculated to assess their predictive ability for 30-day mortality using receiver operating characteristic (ROC) curves and corresponding areas under the curve (AUC). Results. A total of 203 patients were included during the study period, of whom 33% underwent isolated coronary bypass surgery. The overall 30- day mortality rate was 17.6%. Patients who died within the first 30 days exhibited higher scores on EuroSCORE II, STS, and the Electronic Frailty Index. The areas under the ROC curves were: EuroSCORE II, 0.74 (95% CI: 0.66-0.81); STS, 0.66 (95% CI: 0.57-0.77); Charlson Comorbidity Index, 0.60 (95% CI: 0.49-0.70); and Electronic Frailty Index, 0.63 (95% CI: 0.52-0.73). Conclusions. In this cohort of elderly patients undergoing cardiac surgery, EuroSCORE II demonstrated the best performance in predicting 30-day mortality.

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Referencias

Curiel-Balsera E, Mora-Ordoñez JM, Castillo-Lorente E, Benítez-Parejo J, Herruzo-Avilés A, Ravina-Sanz JJ, et al. Mortality and complications in elderly patients undergoing cardiac surgery. J Crit Care. 2013;28(4):397-404. doi:10.1016/j.jcrc.2012.12.011.

Arnaoutakis GJ, George TJ, Alejo DE, Merlo CA, Baumgartner WA, Cameron DE, et al. Society of Thoracic Surgeons Risk Score predicts

hospital charges and resource use after aortic valve replacement. J Thorac Cardiovasc Surg. 2011;142(3):650-5. doi:10.1016/j.jtcvs.2011.02.038.

Sündermann S, Dademasch A, Praetorius J, Kempfert J, Dewey T, Falk V, et al. Comprehensive assessment of frailty for elderly highrisk patients undergoing cardiac surgery. Eur J Cardiothorac Surg. 2011;39(1):33-7. doi:10.1016/j.ejcts.2010.04.013.

Shan L, Ge W, Pu Y, Cheng H, Cang Z, Zhang X, et al. Assessment of three risk evaluation systems for patients aged ≥70 in East China: performance of SinoSCORE, EuroSCORE II and the STS risk evaluation system. PeerJ. 2018;6:e4413. doi:10.7717/peerj.4413.

Siregar S, Groenwold RH, de Heer F, Bots ML, van der Graaf Y, van Herwerden LA. Performance of the original EuroSCORE. Eur J Cardiothorac Surg. 2012;41(4):746-54. doi:10.1093/ejcts/ezr285.

Taleb Bendiab T, Brusset A, Estagnasié P, Squara P, Nguyen LS. Performance of EuroSCORE II and Society of Thoracic Surgeons risk scores in elderly patients undergoing aortic valve replacement surgery. Arch Cardiovasc Dis. 2021;114(6-7):474-481. doi:10.1016/j.acvd.2020.12.004.

Rodríguez-Chávez LL, Figueroa-Solano J, Muñoz-Consuegra CE, Avila-Vanzzini N, Kuri-Alfaro J. EuroSCORE subestima el riesgo de mortalidad en cirugía cardiaca valvular de población mexicana [EuroSCORE underestimate the mortality risk in cardiac valve surgery of Mexican population]. Arch Cardiol Mex. 2017;87(1):18-25. doi:10.1016/j.acmx.2016.07.001.

Lee JA, Yanagawa B, An KR, Arora RC, Verma S, Friedrich JO, et al. Frailty and pre-frailty in cardiac surgery: a systematic review and meta-analysis of 66,448 patients. J Cardiothorac Surg. 2021;16(1):184. doi:10.1186/s13019-021-01541-8.

Graham A, Brown CH 4th. Frailty, Aging, and Cardiovascular Surgery. Anesth Analg. 2017;124(4):1053-1060. doi:10.1213/ANE.0000000000001560.

Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2022;43(7):561-632. doi:10.1093/eurheartj/ehab395.

Afilalo J, Lauck S, Kim DH, Lefèvre T, Piazza N, Lachapelle K, et al. Frailty in Older Adults Undergoing Aortic Valve Replacement: The FRAILTYAVR Study. J Am Coll Cardiol. 2017;70(6):689-700. doi:10.1016/j.jacc.2017.06.024.

Afilalo J, Alexander KP, Mack MJ, Maurer MS, Green P, Allen LA, et al. Frailty assessment in the cardiovascular care of older adults. J Am Coll Cardiol. 2014;63(8):747-62. doi:10.1016/j.jacc.2013.09.070.

Klein LW, Edwards FH, DeLong ER, Ritzenthaler L, Dangas GD, Weintraub WS. ASCERT: the American College of Cardiology Foundation--the Society of Thoracic Surgeons Collaboration on the comparative effectiveness of revascularization strategies. JACC Cardiovasc Interv. 2010;3(1):124-6. doi:10.1016/j.jcin.2009.11.005.

Coyan GN, Chin H, Shah A, Miguelino AM, Wang Y, Kilic A, et al. Charlson Comorbidity Index is Associated With Longer-Term Mortality and Re-Admissions Following Coronary Artery Bypass Grafting. J Surg Res. 2022;275:300-307. doi:10.1016/j.jss.2022.02.012.

Nashef SA, Roques F, Sharples LD, Nilsson J, Smith C, Goldstone AR, et al. EuroSCORE II. Eur J Cardiothorac Surg. 2012;41(4):734-44; discussion 744-5. doi:10.1093/ejcts/ezs043.

O’Brien SM, Feng L, He X, Xian Y, Jacobs JP, Badhwar V, et al. The Society of Thoracic Surgeons 2018 Adult Cardiac Surgery Risk Models: Part 2-Statistical Methods and Results. Ann Thorac Surg. 2018 May;105(5):1419-1428. doi: 10.1016/j.athoracsur.2018.03.003.

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-383. doi:10.1016/0021-9681(87)90171-8.

Clegg A, Bates C, Young J, Ryan R, Nichols L, Ann Teale E, et al. Development and validation of an electronic frailty index using routine primary care electronic health record data. Age Ageing. 2016;45(3):353-60. doi:10.1093/ageing/afw039.

Jones JM, Loubani M, Grant SW, Goodwin AT, Trivedi U, Kendall S, et al. Cardiac surgery in older patients: hospital outcomes during a 15-year period from a complete national series. Interact Cardiovasc Thorac Surg. 2022;34(4):532-539. doi:10.1093/icvts/ivab320.

Flather M, Rhee JW, Boothroyd DB, Boersma E, Brooks MM, Carrié D, et al. The effect of age on outcomes of coronary artery bypass surgery compared with balloon angioplasty or bare-metal stent implantation among patients with multivessel coronary disease. A collaborative analysis of individual patient data from 10 randomized trials. J Am Coll Cardiol. 2012;60(21):2150-7. doi:10.1016/j.jacc.2012.08.982.

Dixon LK, Di Tommaso E, Dimagli A, Sinha S, Sandhu M, Benedetto U, et al. Impact of sex on outcomes after cardiac surgery: A systematic review and meta-analysis. Int J Cardiol. 2021;343:27-34. doi:10.1016/j.ijcard.2021.09.011.

Afilalo J, Steele R, Manning WJ, Khabbaz KR, Rudski LG, Langlois Y, et al. Derivation and Validation of Prognosis-Based Age Cutoffs to Define Elderly in Cardiac Surgery. Circ Cardiovasc Qual Outcomes. 2016;9(4):424-31. doi:10.1161/CIRCOUTCOMES.115.002409.

Dalrymple-Hay MJ, Alzetani A, Aboel-Nazar S, Haw M, Livesey S, Monro J. Cardiac surgery in the elderly. Eur J Cardiothorac Surg. 1999;15(1):61-6. doi:10.1016/s1010-7940(98)00286-3.

Rady MY, Ryan T, Starr NJ. Perioperative determinants of morbidity and mortality in elderly patients undergoing cardiac surgery. Crit Care Med. 1998;26(2):225-235. doi:10.1097/00003246-199802000-00016

Poullis M, Pullan M, Chalmers J, Mediratta N. The validity of the original EuroSCORE and EuroSCORE II in patients over the age of seventy. Interact Cardiovasc Thorac Surg. 2015 Feb;20(2):172-7. doi: 10.1093/icvts/ivu345.

Provenchère S, Chevalier A, Ghodbane W, Bouleti C, Montravers P, Longrois D, et al. Is the EuroSCORE II reliable to estimate operative mortality among octogenarians? PLoS One. 2017 Nov 16;12(11):e0187056. doi: 10.1371/journal.pone.0187056.

Lytwyn J, Stammers AN, Kehler DS, Jung P, Alexander B, Hiebert BM, et al. The impact of frailty on functional survival in patients 1 year after cardiac surgery. J Thorac Cardiovasc Surg. 2017 Dec;154(6):1990-1999. doi: 10.1016/j.jtcvs.2017.06.040.

Saetang M, Rewurai N, Oofuvong M, Chanchayanon T, Packawatchai P, Khunpanich P. Preoperative Modified Frailty Index-11 versus EuroSCORE II in Predicting Postoperative Mortality and Complications in Elderly Patients Who Underwent Elective Open Cardiac Surgery: A Retrospective Cohort Study. J Cardiothorac Vasc Anesth. 2024 Nov;38(11):2613-2623. doi: 10.1053/j.jvca.2024.08.018.

Bäck C, Hornum M, Jørgensen MB, Lorenzen US, Olsen PS, Møller CH. Comprehensive assessment of frailty score supplements the existing cardiac surgical risk scores. Eur J Cardiothorac Surg. 2021 Sep 11;60(3):710-716. doi: 10.1093/ejcts/ezab127.

Li Z, Ding X. The incremental predictive value of frailty measures in elderly patients undergoing cardiac surgery: A systematic review. Clin Cardiol. 2018;41(8):1103-1110. doi:10.1002/clc.23021.

Edwards MB, Taylor KM. Is 30-day mortality an adequate outcome statistic for patients considering heart valve replacement? Ann Thorac Surg. 2003;76(2):482-5; discussion 486. doi:10.1016/s0003-4975(03)00350-3.

Barili F, Pacini D, D’Ovidio M, Dang NC, Alamanni F, Di Bartolomeo R, et al. The Impact of EuroSCORE II Risk Factors on Prediction of Long-Term Mortality. Ann Thorac Surg. 2016;102(4):1296-1303.. doi: 10.1016/j.athoracsur.2016.04.017