Changing performance of surgical risk scores according to the endpoint of postoperative mortality in infective endocarditis patients
BackgroundThe optimal endpoint for reporting early mortality after cardiac operations for infective endocarditis (IE), as well as the optimal mortality target for surgical risk scores, are unresolved questions.MethodsFive risk scores created specifically to predict early mortality after cardiac oper...
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Frontiers Media S.A.
2025-03-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1543049/full |
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| author | Giuseppe Gatti Antonio Fiore Maria Ismail Igor Vendramin Alessandro Minati Gianfranco Sinagra Andrea Perrotti Enzo Mazzaro |
| author_facet | Giuseppe Gatti Antonio Fiore Maria Ismail Igor Vendramin Alessandro Minati Gianfranco Sinagra Andrea Perrotti Enzo Mazzaro |
| author_sort | Giuseppe Gatti |
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| description | BackgroundThe optimal endpoint for reporting early mortality after cardiac operations for infective endocarditis (IE), as well as the optimal mortality target for surgical risk scores, are unresolved questions.MethodsFive risk scores created specifically to predict early mortality after cardiac operations for definite IE, and the European System for Cardiac Operative Risk Evaluation II, were assessed in terms of calibration, discrimination and accuracy in predicting early mortality following cardiac surgery for IE. The evaluation was based on five definite endpoints of postoperative mortality: In-hospital, 30-day, in-hospital/30-day, six-month, and one-year mortality. The six risk scores were tested in a population of 991 patients with definite IE who underwent 1,014 cardiac operations at five European university-affiliated centers.ResultsThere were 133 (13.1%) hospital deaths after surgery. Overall, 10% of patients died within 30 days after surgery, 10.4% of survivors died between 30 days and six months after surgery, and another 5.5% between six months and one year after surgery. All risk scores showed good prediction accuracy and at least acceptable discrimination for all endpoints of postoperative mortality. However, only one (IE-specific) risk score exhibited acceptable calibration for every endpoint of postoperative mortality.ConclusionsSince mortality decreases slowly throughout the first year after cardiac surgery for IE, it may be appropriate to report both in-hospital and one-year mortality (coupled endpoint) for this condition. For both endpoints, only one of the risk scores considered in this study showed acceptable calibration and discrimination. |
| format | Article |
| id | doaj-art-8d041d69d80540a3a43183fe68554bb8 |
| institution | OA Journals |
| issn | 2297-055X |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj-art-8d041d69d80540a3a43183fe68554bb82025-08-20T02:04:51ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-03-011210.3389/fcvm.2025.15430491543049Changing performance of surgical risk scores according to the endpoint of postoperative mortality in infective endocarditis patientsGiuseppe Gatti0Antonio Fiore1Maria Ismail2Igor Vendramin3Alessandro Minati4Gianfranco Sinagra5Andrea Perrotti6Enzo Mazzaro7Cardio-Thoracic and Vascular Department, University Hospital of Trieste, Trieste, ItalyDepartment of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris and Université Paris Est, Créteil, FranceDepartment of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz and University of Franche-Comté, Besançon, FranceDepartment of Cardiac Surgery, Ospedale Santa Maria Della Misericordia, Udine, ItalyDepartment of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, La Sapienza University, Rome, ItalyCardio-Thoracic and Vascular Department, University Hospital of Trieste, Trieste, ItalyDepartment of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz and University of Franche-Comté, Besançon, FranceCardio-Thoracic and Vascular Department, University Hospital of Trieste, Trieste, ItalyBackgroundThe optimal endpoint for reporting early mortality after cardiac operations for infective endocarditis (IE), as well as the optimal mortality target for surgical risk scores, are unresolved questions.MethodsFive risk scores created specifically to predict early mortality after cardiac operations for definite IE, and the European System for Cardiac Operative Risk Evaluation II, were assessed in terms of calibration, discrimination and accuracy in predicting early mortality following cardiac surgery for IE. The evaluation was based on five definite endpoints of postoperative mortality: In-hospital, 30-day, in-hospital/30-day, six-month, and one-year mortality. The six risk scores were tested in a population of 991 patients with definite IE who underwent 1,014 cardiac operations at five European university-affiliated centers.ResultsThere were 133 (13.1%) hospital deaths after surgery. Overall, 10% of patients died within 30 days after surgery, 10.4% of survivors died between 30 days and six months after surgery, and another 5.5% between six months and one year after surgery. All risk scores showed good prediction accuracy and at least acceptable discrimination for all endpoints of postoperative mortality. However, only one (IE-specific) risk score exhibited acceptable calibration for every endpoint of postoperative mortality.ConclusionsSince mortality decreases slowly throughout the first year after cardiac surgery for IE, it may be appropriate to report both in-hospital and one-year mortality (coupled endpoint) for this condition. For both endpoints, only one of the risk scores considered in this study showed acceptable calibration and discrimination.https://www.frontiersin.org/articles/10.3389/fcvm.2025.1543049/fullcardiac surgeryEuroSCOREinfective endocarditisearly postoperative mortalityendpointprediction |
| spellingShingle | Giuseppe Gatti Antonio Fiore Maria Ismail Igor Vendramin Alessandro Minati Gianfranco Sinagra Andrea Perrotti Enzo Mazzaro Changing performance of surgical risk scores according to the endpoint of postoperative mortality in infective endocarditis patients Frontiers in Cardiovascular Medicine cardiac surgery EuroSCORE infective endocarditis early postoperative mortality endpoint prediction |
| title | Changing performance of surgical risk scores according to the endpoint of postoperative mortality in infective endocarditis patients |
| title_full | Changing performance of surgical risk scores according to the endpoint of postoperative mortality in infective endocarditis patients |
| title_fullStr | Changing performance of surgical risk scores according to the endpoint of postoperative mortality in infective endocarditis patients |
| title_full_unstemmed | Changing performance of surgical risk scores according to the endpoint of postoperative mortality in infective endocarditis patients |
| title_short | Changing performance of surgical risk scores according to the endpoint of postoperative mortality in infective endocarditis patients |
| title_sort | changing performance of surgical risk scores according to the endpoint of postoperative mortality in infective endocarditis patients |
| topic | cardiac surgery EuroSCORE infective endocarditis early postoperative mortality endpoint prediction |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1543049/full |
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