Heart 1998;79:350-355 ( April )

Predicting operative risk for coronary artery surgery in the United Kingdom: a comparison of various risk prediction algorithms

B Bridgewater,^a H Neve,^a N Moat,^b T Hooper,^a M Jones^a

^a Departments of Cardiothoracic Surgery and Clinical Audit, Wythenshawe Hospital, Manchester, UK, ^b Department of Cardiac Surgery, Royal Brompton Hospital, London SW3, UK

Correspondence to: Mr B J M Bridgewater, Department of Cardiothoracic Surgery, Green Lane Hospital, Green Lane West, Auckland 3, New Zealand. email: bbridge{at}nznet.gen.nz

Accepted for publication 3 October 1997

ObjectiveTo compare the ability of four risk models to predict operative mortality after coronary artery bypass graft surgery (CABG) in the United Kingdom.
DesignProspective study.
SettingTwo cardiothoracic centres in the United Kingdom.
Subjects1774 patients having CABG.
Main outcome measuresRisk factors were recorded for all patients, along with in-hospital mortality. Predicted mortality was derived from the American Society of Thoracic Surgeons (STS) risk program, Ontario Province risk score (PACCN), Parsonnet score, and the UK Society of Cardiothoracic Surgeons risk algorithm.
ResultsThere were significant differences (p < 0.05) between the British and American populations from which the STS risk algorithm was derived with respect to most variables. The observed mortality in the British population was 3.7% (65 of 1774). The mean pre- dicted mortality by STS score, PACCN, Parsonnet score, and UK algorithms were 1.1%, 1.6%, 4.6%, and 4.7% respectively. The overall predictive ability of the models as measured by the area under the receiver operating characteristic curve were 0.64, 0.60, 0.73, and 0.75, respectively.
ConclusionsThere are differences between the British and American populations for CABG and the North American algorithms are not useful for predicting mortality in the United Kingdom. The UK Society of Cardiothoracic Surgeons algorithm is the best of the models tested but still only has limited predictive ability. Great care must be exercised when using methods of this type for comparisons of units and surgeons.

Keywords: cardiac surgery;  risk stratification;  audit

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© 1998 by Heart
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