External and Temporal Validation 10 Years after the Development of the First Latin-American Risk Stratification Score for Cardiac Surgery (ArgenSCORE)

Victorio Carosella, Hugo Grancelli, Walter Rodriguez, Miguel Sellanes, Miguel Caceres, Hernan Cohen Arazi, Cesar Cardenas, Carlos Nojek

Abstract


Background

During the last decades, several risk assessment models

have been applied to predict the risk of mortality after cardiac

surgery; however, none of them have been developed 

in Latin American populations. These models have inferior

performance when applied to patient groups other than the

ones on whom they were developed.

Objectives

To perform external and temporal validation of a local risk

score for cardiac surgery [Argentinean System for Cardiac

Operative Risk Evaluation (ArgenSCORE)] and compare it

to the EuroSCORE.

Material and Methods

A total of 5268 consecutive adult patients undergoing cardiac

surgery were included from June 1994 to December 2009. The

risk model was developed through logistic regression on the

data of 2903 patients who underwent cardiac surgery between

June 1994 and December 1999 at a center. Prospective internal

validation was performed on 708 patients between January

2000 and June 2001. External and temporal validation of the

recalibrated model were performed between February 2000

and December 2009, evaluating model discrimination and

calibration in patients operated on at four centers different

from the one where the score had been originally developed.

The method was also compared to the EuroSCORE.

Results

The external validation was performed on 1657 patients,

mean age was 62.8±13.3 years and global mortality was

4.58%. The ArgenSCORE showed both good discriminatory

power with an area under the ROC curve of 0.80 and predictive

capacity for risk assessment in all patients (observed

mortality 4.58% vs. expected mortality 4.54%; p=0.842). The

EuroSCORE showed good discriminatory power (area under

the ROC curve of 0.79) but overestimated the risk (observed

mortality 4.58% vs. expected mortality 5.23%; p <0.0001).

Conclusions

The ArgenSCORE showed an adequate capacity to predict

in-hospital mortality in cardiac surgery 10 years after being

developed. The score can be applied to populations with similar

geographic characteristics, showing a better performance compared

to an established international risk stratification model.


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Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020 www.sac.org.ar revista@sac.org.ar