Reliability of EuroSCORE II on Prediction of Thirty-Day Mortality and Long-Term Results in Patients Treated with Sutureless Valves
Abstract
:1. Introduction
2. Materials and Methods
Statistical Analysis
3. Results
3.1. 30-Day Mortality
3.2. Follow-Up
4. Discussion
- EuroSCORE II overestimated the risk of mortality with an E/O ratio of 0.64 (95% IC: 0.49–0.89) in patients who underwent Su-AVR;
- The ROC curve tested on the whole population showed an acceptable accuracy of EuroSCORE II in estimating 30-day mortality with an AUC of 0.65;
- In the L-ES2 subgroup, EuroSCORE II had good predictive power with an E/O ratio of 0.98 (0.45–1.96);
- In patients younger than 75 years, the ROC curve showed good estimation performance in 30-day mortality with an AUC of 0.75. Suboptimal results were observed in patients older than 75 years, with an AUC of 0.61;
- The ROC curve showed a performance barely acceptable when ES II was used to estimate the risk of mortality at 60 months follow-up (AUC 0.64).
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variables | SUAVR (n = 1126 pts) | Low Risk (n = 406 pts) | Intermediate Risk (n = 545) | High Risk (n = 175) | p-Value | ||||
---|---|---|---|---|---|---|---|---|---|
n (%) | n (%) | n (%) | n (%) | ||||||
Surgical approach | |||||||||
Sternotomy | 284 | 25.2% | 95 | 23.4% | 147 | 27.0% | 57 | 32.6% | <0.001 |
Ministernotomy | 674 | 59.9% | 297 | 73.2% | 259 | 47.5% | 118 | 67.4% | |
Right anterior thoracotomy | 168 | 14.9% | 14 | 3.4% | 139 | 25.5% | 0 | 0.0% | |
Non-elective procedure | 18 | 1.6% | 2 | 0.5% | 11 | 2.0% | 5 | 2.9% | 0.019 |
Aortic cross-clamp (min) (mean ± SD) | 43.9 | 21.2 | 41.4 | 18.8 | 48.7 | 22.7 | 36.4 | 19.6 | <0.001 |
CPB (min) (mean ± SD) | 69.4 | 31.5 | 63.8 | 28.4 | 77.5 | 32.5 | 61.6 | 31.8 | <0.001 |
Intraprocedural mortality | 7 | 0.6% | 3 | 0.7% | 2 | 0.4% | 2 | 1.1% | 0.568 |
30-Day mortality | 34 | 3.0% | 9 | 2.2% | 19 | 3.5% | 6 | 3.4% | 0.540 |
AKI | 37 | 3.3% | 16 | 3.9% | 12 | 2.2% | 9 | 5.1% | 0.048 |
Stroke/TIA | 38 | 3.4% | 12 | 2.9% | 18 | 3.3% | 8 | 4.6% | 0.021 |
Life-threatening bleeding | 59 | 5.2% | 20 | 4.9% | 30 | 5.5% | 9 | 5.1% | 0.985 |
Intraprocedural AMI | 1 | 0.1% | 0 | 0.0% | 0 | 0.0% | 1 | 0.6% | 0.987 |
Permanent PM implantation | 79 | 7.0% | 30 | 7.4% | 35 | 6.4% | 14 | 8.0% | 0.669 |
Paravalvular leak ≥ 2 | 11 | 1.0% | 3 | 0.7% | 6 | 1.1% | 2 | 1.1% | 0.845 |
Endocarditis | 19 | 1.7% | 2 | 0.5% | 12 | 2.2% | 5 | 2.8% | 0.063 |
Pneumonia | 35 | 3.1% | 5 | 1.2% | 23 | 4.2% | 7 | 4.0% | 0.125 |
Transfusions | 343 | 30.5% | 93 | 22.9% | 179 | 32.8% | 71 | 40.6% | <0.001 |
DSWI | 11 | 1.0% | 3 | 0.7% | 6 | 1.1% | 2 | 1.1% | 0.816 |
A | Low Risk | Intermediate Risk | High Risk |
n = 406 | n = 545 | n = 175 | |
O/E ratio (95%CI) | 0.98 (0.45–1.96) | 0.61 (0.37–0.96) | 0.30 (0.11–0.65) |
AUROC (95%CI) | 0.76 (0.64–0.89) | 0.64 (0.53–0.74) | 0.58 (0.41–0.75) |
AUROC p-value | p = 0.004 | p = 0.023 | p = 0.422 |
Bonferroni correction | 0.008 | 0.046 | 0.844 |
HL goodness-of-fit test | |||
calibration p-value | 0.381 | 0.061 | 0.098 |
Bonferroni correction | 0.762 | 0.122 | 0.196 |
B | Overall Population | Age ≤ 75 yrs | Age > 75 |
n = 1126 | n = 292 | n = 834 | |
O/E ratio (95%CI) | 0.64 (0.49–0.89) | 0.54 (0.23–1.20) | 0.47 (0.22–0.71) |
AUROC (95%CI) | 0.65 (0.56–0.72) | 0.75 (0.65–0.87) | 0.62 (0.50–0.71) |
AUROC p-value | p < 0.001 | p < 0.001 | p = 0.027 |
Bonferroni correction | <0.001 | <0.001 | 0.844 |
HL goodness-of-fit test | |||
Calibration p-value | 0.399 | 0.534 | 0.046 |
Bonferroni Correction | 0.798 | 0.999 | 0.092 |
Univariable | Multivariable | |||||||
---|---|---|---|---|---|---|---|---|
HR | LCI | UCI | p-Value | HR | LCI | UCI | p-Value | |
ESII ≥ 8% (versus low and intermediate risk) | 2.10 | 1.51 | 2.92 | <0.001 | 1.82 | 1.29 | 2.56 | <0.001 |
Age | 1.03 | 1.00 | 1.05 | 0.029 | ||||
Male Gender | 1.38 | 1.04 | 1.83 | 0.025 | ||||
BSA | 0.61 | 0.28 | 1.30 | 0.203 | ||||
Active Smoker | 0.85 | 0.55 | 1.29 | 0.456 | ||||
Diabetes Mellitus | 1.31 | 0.97 | 1.77 | 0.068 | ||||
Previous Atrial Fibrillation | 2.40 | 1.62 | 3.57 | <0.001 | 1.74 | 1.14 | 2.65 | 0.009 |
PAD | 1.06 | 0.74 | 1.51 | 0.729 | ||||
Previous CABG | 0.98 | 0.40 | 2.41 | 0.974 | ||||
Previous Stroke/TIA | 1.57 | 0.98 | 2.52 | 0.055 | ||||
COPD | 1.19 | 0.84 | 1.71 | 0.318 | ||||
Advanced NYHA | 1.36 | 1.01 | 1.84 | 0.039 | ||||
CKF | 1.59 | 0.90 | 1.78 | 0.109 | ||||
LVEF < 30% | 0.98 | 0.97 | 0.99 | 0.008 | ||||
Bicuspid Aortic Valve | 0.36 | 0.16 | 0.83 | 0.016 | ||||
Preoperative MR > Grade II | 1.06 | 0.63 | 1.78 | 0.802 |
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Di Bacco, L.; D’Alonzo, M.; Baudo, M.; Montisci, A.; Di Eusanio, M.; Folliguet, T.; Solinas, M.; Miceli, A.; Fischlein, T.; Rosati, F.; et al. Reliability of EuroSCORE II on Prediction of Thirty-Day Mortality and Long-Term Results in Patients Treated with Sutureless Valves. J. Clin. Med. 2024, 13, 3986. https://doi.org/10.3390/jcm13133986
Di Bacco L, D’Alonzo M, Baudo M, Montisci A, Di Eusanio M, Folliguet T, Solinas M, Miceli A, Fischlein T, Rosati F, et al. Reliability of EuroSCORE II on Prediction of Thirty-Day Mortality and Long-Term Results in Patients Treated with Sutureless Valves. Journal of Clinical Medicine. 2024; 13(13):3986. https://doi.org/10.3390/jcm13133986
Chicago/Turabian StyleDi Bacco, Lorenzo, Michele D’Alonzo, Massimo Baudo, Andrea Montisci, Marco Di Eusanio, Thierry Folliguet, Marco Solinas, Antonio Miceli, Theodor Fischlein, Fabrizio Rosati, and et al. 2024. "Reliability of EuroSCORE II on Prediction of Thirty-Day Mortality and Long-Term Results in Patients Treated with Sutureless Valves" Journal of Clinical Medicine 13, no. 13: 3986. https://doi.org/10.3390/jcm13133986
APA StyleDi Bacco, L., D’Alonzo, M., Baudo, M., Montisci, A., Di Eusanio, M., Folliguet, T., Solinas, M., Miceli, A., Fischlein, T., Rosati, F., & Muneretto, C. (2024). Reliability of EuroSCORE II on Prediction of Thirty-Day Mortality and Long-Term Results in Patients Treated with Sutureless Valves. Journal of Clinical Medicine, 13(13), 3986. https://doi.org/10.3390/jcm13133986