SinoSCORE: a logistically derived additive prediction model for post-coronary artery bypass grafting in-hospital mortality in a Chinese population

Abstract

This study aims to construct a logistically derived additive score for predicting in-hospital mortality risk in Chinese patients undergoing coronary artery bypass surgery (CABG). Data from 9839 consecutive CABG patients in 43 Chinese centers were collected between 2007 and 2008 from the Chinese Coronary Artery Bypass Grafting Registry. This database was randomly divided into developmental and validation subsets (9:1). The data in the developmental dataset were used to develop the model using logistic regression. Calibration and discrimination characteristics were assessed using the validation dataset. Thresholds were defined for each model to distinguish different risk groups. After excluding 275 patients with incomplete information, the overall mortality rate of the remaining 9564 patients was 2.5%. The SinoSCORE model was constructed based on 11 variables: age, preoperative NYHA stage III or IV, chronic renal failure, extracardiac arteriopathy, chronic obstructive pulmonary disease, preoperative atrial fibrillation or flutter (within 2βweeks), left ventricular ejection fraction, other elective surgery, combined valve procedures, preoperative critical state, and BMI. In the developmental dataset, calibration using a Hosmer-Lemeshow (HL) test was at P =β0.44 and discrimination based on the area under the receiver operating characteristic curve (ROC) was 0.80. In the validation dataset, the HL test was at P =β0.34 and the area under the ROC (AUC) was 0.78. A logistically derived additive model for predicting in-hospital mortality among Chinese patients undergoing CABG was developed based on the most up-to-date multi-center data from China.

Keywords

coronary artery bypass grafting / risk stratification / in-hospital mortality

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Acknowledgements

This research was supported by a grant from the National Eleventh Five-year Project of China.

This study was conducted on behalf of the Chinese CABG Registry Study. The consultant surgeons involved are as follows (in alphabetical order): Haisheng Chen, Liangwan Chen, Xin Chen, Yifan Chi, Zhaoyun Cheng, Nianguo Dong, Tianxiang Gu, Jianguo Hu, Shengshou Hu, Tao Han, Shulin Jiang, Ye Kong, Jiali Liang, Jianshi Liu, Su Liu, Yingze Li, Xiaocheng Liu, Zhiyong Liu, Chengchao Sun, Peixiong Su, Liang Tao, Chuzhong Tang, Fenglin Wang, Junsheng Wang, Chunsheng Wang, Mingying Wu, Ruobin Wu, Shuming Wu, Dong Xu, Feng Xiao, Jiyan Xie, Mingdi Xiao, Yingbin Xiao, Ping Xu, Xiangming Xu, Zhiyun Xu, Song Xue, Biao Yuan, Chuanrui Yang, Dinghua Yi, Qiang Zhao, Kaiguang Zhang, Shunye Zhang, Wenjun Zhen, and Chengwei Zou. We acknowledge the assistance of each center (see below) for the collection and validation of the data. We also thank the Chinese CABG Registry Study database working staff (Dr. Huawei Gao, Xin Pang, Li He, Qiulan Xie, Liping Zhang) for their industrious efforts.

The 43 centers (alphabetical order) that participated in the Chinese CABG registry study (2007-2008) were as follows:

Beijing University First Hospital, Beijing University People’s Hospital, Beijing Friendship Hospital, Beijing Chaoyang Hospital, Beijing Xuanwu Hospital, Beijing Tongren Hospital, Beijing Hospital, China PLA Changhai Hospital, China PLA No. 3 Medical University Second Hospital, China PLA Jinan General Hospital, China PLA No. 4 Medical University First Hospital, China Medical University First Hospital, Fuwai Hospital, Fujian Provincial Cardiovascular Institute, Fujian Medical University Union Hospital, Fudan University Zhongshan Hospital, Guangdong Gaozhou People’s Hospital, Guangdong Provincial Cardiovascular Institute, Haerbin Medical University Second Hospital, Hebei Medical University Second Hospital, Henan Anyang People’s Hospital, Henan People’s Hospital, Jining Medical College Hospital, Jiangsu People’s Hospital, Nanjing South-east University Zhongda Hospital, Nanjing Medical University First Hospital, Qingdao University Hospital, Shandong University Qilu Hospital, Shandong Provincial Hospital, Sino-Japan Friendship Hospital, Shanghai Ruijin Hospital, Shanghai Renji Hospital, Shanghai Chest Hospital, Shanghai First People’s Hospital, Shanxi Provincial Heart Hospital, Tongji Medical University Union Hospital, Tianjin Taida Heart Hospital, Tianjin Chest Hospital, Wuhan Asia Heart Hospital, Wenzhou Medical College First Hospital, Xuzhou Central Hospital, and Zhongnan University Xiangya Second Hospital.

Compliance with ethics guidelines

Zhe Zheng, Lu Zhang, Xi Li, and Shengshou Hu declare no conflicts of interest. This study was approved by the ethics committee of Fuwai Cardiovascular Hospital.

RIGHTS & PERMISSIONS

2014 Higher Education Press and Springer-Verlag Berlin Heidelberg