非体外循环冠状动脉旁路移植术后早期死亡风险预测——SinoSCORE与EuroSCORE评分的对比

The prediction of early mortality in off-pump coronary artery bypass surgery ： SinoSCORE versus EuroSCORE

目的 比较中国冠状动脉旁路移植手术评分系统（SinoSCORE）和欧洲心脏外科手术风险评分系统（EuroSCORE）对中国人群非体外循环冠状动脉旁路移植（OPCAB）术后早期死亡风险的预测价值.方法 OPCAB病人资料来自中国心血管外科注册登记研究2004-2005年数据库,观察终点为术后院内死亡.分别用SinoSCORE和logistic EuroSCORE两种模型计算病人预计病死率,并与实际病死率比较.校准度采用Hosmer-Lemeshow拟合优度检验,利用 ROC曲线下面积（AUC）评价模型的区分度.结果 4920例病人中73例发生院内死亡,实际病死率1.48%,SinoSCORE模型和EuroSCORE模型预测的病死率分别为2.73%、4.13%.SinoSCORE模型Hosmer-Lemeshow拟合优度检验P=0.636,AUC=0.794;EuroSCORE模型Hosmer-Lemeshowrny拟合优度检验P=0.01,AUC=0.756.SinoSCORE和logistic EuroSCORE两种模型的区分度均较好,但SinoSCORE的校准度明显优于后者,即两种模型均能预测术后死亡,但SinoSCORE对术后病死率的预测更加准确.结论 SinoSCORE模型比EuroSCORE模型更适用于中国非体外循环冠状动脉旁路移植病人术后早期死亡预测.

Objective To compare the validation of the Sino System for Coronary Operative Risk Evaluation （ SinoSCORE ） with the Europe an system for cardiac operative risk evaluation （ EuroSCORE ） in patients undergoing off-pump coronary artery bypass （OPCAB） surgery in China. Methods Data of patients who underwent OPCAB between 2004 and 2005 in the Chinese coronary artery bypass grafting registry study were collected. The end point of the study was postoperative in-hospital death. Predicted mortality were calculated using the SinoSCORE and the logistic EuroSCORE, and compared with observed mortality. Calibration was evaluated by Hosmer-Lemeshow goodness-of-fit test. Discrimination was tested by determining the area under the receiver operating characteristic（ROC） curve. Results 73 of 4920 patients died in hospital and the observed mortality was 1.48%. The predicted mortality calculated by the SinoSCORE and the EuroSCORE was 2.73% and 4. 13% respectively. For SinoSCORE the Hosmer-Lemeshow test was non-significant （ P = 0. 636 ） and the area under ROC curve was 0. 794. For the EuroSCORE the HL test was significant（ P = 0.01 ） and the area under ROC curve was 0. 756. Both the SinoSCORE and the logistic EuroSCORE provides good discrimination, but the SinoSCORE showed better calibration than EuroSCORE, that is, both the two models were significantly correlated to postoperative death, but SinoSCORE is more accurate than EuroSCORE at predicting postoperative in-hospital mortality. Conclusion SinoSCORE seems to be more suitable than EuroSCORE in predicting postoperative in-hospital mortality for OPCAB patients in China.