上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

SinoSCORE与EuroSCORE对不停跳冠状动脉旁路术后早期死亡预测评估比较

连 锋，戴晨阳，张文天，路喆鑫，谢 波，胡振雷，黄日太，徐根兴，薛 松   

  1. 上海交通大学  医学院附属仁济医院心外科， 上海 200127
  • 出版日期:2014-02-28 发布日期:2014-03-25
  • 通讯作者: 薛 松, 电子信箱: xuesong64@163.com。
  • 作者简介:连锋（1970—）， 男， 副教授， 博士， 硕士生导师; 电子信箱: dr.lianfeng@hotmail.com。
  • 基金资助:

    上海市科委基金（12nm0502100）；上海市教委基金（11YZ48，13ZZ091）；上海市浦东新区卫生局基金（PW2010D-2）

Comparison of SinoSCORE and EuroSCORE in prediction of early mortality in off-pump coronary artery bypass surgery

LIAN Feng, DAI Chen-yang, ZHANG Wen-tian, LU Zhe-xin, XIE Bo, HU Zhen-lei, HUANG Ri-tai, XU Gen-xing, XUE Song   

  1. Department of Cardiovascular Surgery, Renji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai 200127, China
  • Online:2014-02-28 Published:2014-03-25
  • Supported by:

    Science and Technology Commission of Shanghai Municipality Foundation, 12nm0502100; Foundation of Shanghai Municipal Education Committee，13ZZ091； Foundation of Shanghai Pudong New Area Health Bureau，PW2010D-2

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摘要：

目的 比较中国冠状动脉旁路移植手术（CABG）评分系统(SinoSCORE)和欧洲心脏外科手术风险评分系统（EuroSCORE）两种模型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，进一步明确SinoSCORE模型是否适用于单纯OPCAB的风险预测。方法 收集上海交通大学医学院附属仁济医院心外科2004年7月—2013年7月的1 530例OPCAB患者，分别采用SinoSCORE和EuroSCORE两种模型预计患者的病死率，并与实际病死率比较，观察终点为术后院内死亡。通过Hosmer-Lemeshow拟合优度检验检测校准度，运用受试者工作特征（ROC）曲线下面积（AUC）评价模型的区分度。结果 1 530例患者中23例发生院内死亡，实际病死率为1.50％。SinoSCORE模型和EuroSCORE模型的预计病死率分别为2.69％和4.73％。SinoSCORE模型的Hosmer-Lemeshow拟合优度检验P=0.612，AUC=0.796； EuroSCORE模型Hosmer-Lemeshowrny拟合优度检验P=0.013，AUC=0.782。两种模型的区分度均较好，但SinoSCORE的校准度和预测准确率明显优于EuroSCORE模型。结论 SinoSCORE模型比EuroSCORE模型更适用于中国OPCAB患者的术后早期死亡预测，是适合中国人不停跳冠状动脉搭桥手术早期死亡评估的风险评估体系。

关键词: 不停跳冠状动脉旁路移植手术, 中国冠状动脉旁路移植手术评分系统, 欧洲心脏外科手术风险评分系统, 死亡评估

Abstract:

Objective To compare the prediction value of the Chinese System for Coronary Operative Risk Evaluation (SinoSCORE) and the European System for Cardiac Operative Risk Evaluation (EuroSCORE) for patients undergoing off-pump coronary artery bypass (OPCAB) surgeries in China, and to confirm the fitness of SinoSCORE for predicting OPCAB. Methods The data of patients who underwent OPCAB between July 2004 and July 2013 in Department of Cardiovascular Surgery of Renji Hospital, Shanghai Jiao Tong University School of Medicine, was collected．SinoSCORE and EuroSCORE were used separately to predict the mortality which was then compared with the observed mortality．The end point of the study was postoperative in-hospital death. Hosmer-Lemeshow goodness-of-fit test was adopted to evaluate calibration．The area under the receiver operating characteristic (ROC) curve was used to assess the discrimination. Results Among 1 530 patients, 23 died in hospital and the observed mortality was 1.50％. The predicted mortalities of SinoSCORE and EuroSCORE were 2.69％ and 4.73％, respectively. Hosmer-Lemeshow test for SinoSCORE was non-significant (P=0.612) and the area under ROC curve (AUC) was 0.796．For EuroSCORE, the Hosmer-Lemeshow test was significant (P=0.013) and the area under ROC curve was 0.782.Both SinoSCORE and EuroSCORE showed good discrimination, but the calibration and prediction of SinoSCORE were better than EuroSCORE. Conclusion SinoSCORE is more suitable than EuroSCORE for predicting postoperative in-hospital mortality of OPCAB patients in China. Moreover, SinoSCORE is an appropriate assessment system for in-hospital mortality prediction for patients undergoing OPCAB in China.

Key words: off-pump coronary artery bypass grafting, SinoSCORE, EuroSCORE, death evaluation