Background:The STICH trial (Surgical Treatment for Ischemic Heart Failure) demonstrated a survival benefit of coronary artery bypass grafting in patients with ischemic cardiomyopathy and left ventricular dysfunction. The Surgical Thoracic Society (STS) risk score and the EuroSCORE-2 (ES2) are used for risk assessment in cardiac surgery, with little information available about their accuracy in patients with left ventricular dysfunction. We assessed the ability of the STS score and ES2 to evaluate 30-day postoperative mortality risk in STICH and a contemporary cohort (CC) of patients with a left ventricle ejection fraction ≤35% undergoing coronary artery bypass grafting outside of a trial setting.Methods and Results:The STS and ES2 scores were calculated for 814 STICH patients and 1246 consecutive patients in a CC. There were marked variations in 30-day postoperative mortality risk from 1 patient to another. The STS scores consistently calculated lower risk scores than ES2 (1.5 versus 2.9 for the CC and 0.9 versus 2.4 for the STICH cohort), and underestimated postoperative mortality risk. The STS and ES2 scores had moderately good C statistics: CC (0.727, 95% CI: 0.650–0.803 for STS, and 0.707, 95% CI: 0.620–0.795 for ES2); STICH (0.744, 95% CI: 0.677–0.812, for STS and 0.736, 95% CI: 0.665–0.808 for ES2). Despite the CC patients having higher STS and ES2 scores than STICH patients, mortality (3.5%) was lower than that of STICH (4.8%), suggesting a possible decrease in postoperative mortality over the past decade.Conclusions:The 30-day postoperative mortality risk of coronary artery bypass grafting in patients with left ventricular dysfunction varies markedly. Both the STS and ES2 score are effective in evaluating risk, although the STS score tend to underestimate risk.CLINICAL TRIAL REGISTRATION:URL: https://www.clinicaltrials.gov. Unique identifier: NCT00023595.

中文翻译：

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外科胸腔社会风险评分和EuroSCORE-2适当评估了STICH试验和接受手术血运重建术的当代左室功能不全患者队列的30天术后死亡率

背景：STICH试验（缺血性心力衰竭的外科手术治疗）证明了缺血性心肌病和左心功能不全的患者冠状动脉搭桥术的生存获益。胸外科协会（STS）风险评分和EuroSCORE-2（ES2）用于心脏手术的风险评估，关于左心功能不全患者准确性的信息很少。我们评估了STS评分和ES2评估STICH和左室射血分数≤35％的左心室射血分数≤35％的患者在试验环境外接受冠状动脉搭桥术的30天术后死亡风险的能力。结果：在CC中，计算了814例STICH患者和1246例连续患者的STS和ES2评分。从一名患者到另一名患者的30天术后死亡风险存在显着差异。STS评分始终计算出比ES2低的风险评分（CC评分为1.5 vs 2.9，STICH队列为0.9 vs 2.4），并且低估了术后死亡风险。STS和ES2得分具有中等良好的C统计：CC（STS为0.727，95％CI：0.650-0.803，ES2为0.707，95％CI：0.620-0.795）；STICH（对于STS为0.744，95％CI：0.677-0.812，对于ES2为0.736，95％CI：0.665-0.808）。尽管CC患者的STS和ES2评分高于STICH患者，但死亡率（3.5％）低于STICH（4.8％），这表明过去十年中术后死亡率可能降低。左心功能不全患者术后30天冠状动脉搭桥术的死亡风险显着不同。尽管STS得分往往会低估风险，但STS和ES2得分都可以有效地评估风险。临床试验注册：URL：https：//www.clinicaltrials.gov。唯一标识符：NCT00023595。