Desempenho do InsCor e de três escores internacionais em cirurgia
                        cardíaca na Santa Casa de Marília

Tiveron, Marcos Gradim; Bomfim, Helton Augusto; Simplício, Maycon Soto; Bergonso, Marcos Henriques; Matos, Milena Paiva Brasil de; Ferreira, Sergio Marques; Pelloso, Eraldo Antônio; Barros, Rubens Tofano de

doi:10.5935/1678-9741.20140116

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Brazilian Journal of Cardiovascular Surgery

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Sumário

ORIGINAL ARTICLES • Rev Bras Cir Cardiovasc 30 (1) • Jan-Mar 2015 • https://doi.org/10.5935/1678-9741.20140116 copiar

Desempenho do InsCor e de três escores internacionais em cirurgia cardíaca na Santa Casa de Marília

Autoria SCIMAGO INSTITUTIONS RANKINGS

Objetivo:

Aplicar e comparar o Society of Thoracic Surgery score (STS), EuroSCORE (Eurosc1), EuroSCORE II (Eurosc2) e InsCor (IS) na predição de mortalidade nos pacientes submetidos à revascularização do miocárdio e/ou cirurgia valvar na Santa Casa de Marília.

Métodos:

O estudo representa uma coorte. É prospectivo, observacional, analítico e unicêntrico. Foram analisados 562 pacientes consecutivos operados de revascularização do miocárdio e/ou cirurgia valvar, entre abril de 2011 e junho de 2013 na Santa Casa de Marília. A mortalidade foi calculada em cada paciente com o uso dos escores STS, Eurosc1, Eurosc2 e IS. A calibração foi calculada utilizando o teste de Hosmer Lemeshow e a discriminação mediante a curva ROC.

Resultados:

A mortalidade hospitalar foi de 4,6%. A calibração foi adequada no grupo geral com P=0,345; P=0,765; P=0,272 e P =0,062 para o STS, Eurosc1, Eurosc2 e IS, respectivamente. O poder discriminatório do STS score 0,649 (IC95% 0,529 P=0,272- 0,770, P=0,012), do Eurosc1 0,706 (IC95% 0,589 - 0,823,P ≤0,001), do Eurosc2 foi 0,704 (IC95% 0,590 - 0,818, P=0,001) e do InsCor 0,739 (IC95% 0,638 - 0,839, P ≤ 0,001).

Conclusão:

Podemos afirmar que no geral o InsCor foi melhor modelo, principalmente na discriminação da amostra estudada. O InsCor mostrou boa acurácia, além de ser efetivo e de fácil aplicação, principalmente por utilizar um menor número de variáveis comparado aos outros modelos.

Fatores de Risco; Mortalidade Hospitalar; Procedimentos Cirúrgicos Cardíacos; Estudos de Validação

Abbreviations, acronyms & symbols
CCS	Canadian Cardiovascular Society
Eurosc1	The European system for cardiac operative risk
Eurosc1	evaluation
Eurosc2	The European system for cardiac operative risk
Eurosc2	evaluation II
NYHA	New York Heart Association
ROC	Receiver Operating Characteristic
SPSS	Statistical Package for the Social Sciences
SP-SCORE	Sao Paulo System for Cardiac Operative Risk
	Evaluation
STS	Society of Thoracic Surgeons score

	Area	CI 95%	se	P
STS-score	0.649	0.529 - 0.770	0.061	0.012
ES	0.706	0.589 - 0.823	0.060	< 0.001
ES II	0.704	0.590 - 0.818	0.058	0.001
InsCor	0.739	0.638 - 0.839	0.051	< 0.001

		Expected mortality (Median)
	Observed mortality	Eurosc1	Eurosc2	STS
Global	4.6%	3.0% (0.8-72)	1.3% (0.5-32)	3.7% (0.2-60)
CABG	3.2%	2.5% (0.8-72)	1.0% (0.5-24)	2.7% (0.2-60)
Valve	6.2%	5.0% (0.8-44)	1.8% (0.5_-32)	9.6% (0.9-59)
CABG + Valve	11.7%	5.8% (1.5-23)	2.8% (0.6-11)	12.5% (1.9-26)

Authors’ roles & responsibilities
MGT	Analysis and/or interpretation of data, final approval of the manuscript conception and study design, conduct of operations, and/or experiments, writing of the manuscript or revising it critically for its content
HAB	Performing the procedures and/or experiments
MSS	Performing the procedures and/or experiments
MHB	Performing the procedures and/or experiments
MPBM	Performing the procedures and/or experiments
SMF	Performing the procedures and/or experiments
EAP	Final approval of manuscript
RTB	Final approval of the manuscript, performing the operations and/or experiments, writing of the manuscript or review of its content

Sociedade Brasileira de Cirurgia Cardiovascular Rua Afonso Celso, 1178 Vila Mariana, CEP: 04119-061 - São Paulo/SP Brazil, Tel +55 (11) 3849-0341, Tel +55 (11) 5096-0079 - São Paulo - SP - Brazil
E-mail: bjcvs@sbccv.org.br

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[1] Correspondence address: Marcos Gradim Tiveron, Santa Casa de Misericórdia de Marília, Av. Vicente Ferreira, 828 - Cascata, Marília, SP, Brazil - Zip code: 17515-000. E-mail: mgtiveron@yahoo.com.br

STS score	Surgical intervention, age, gender, ethnicity, peripheral disease, cerebrovascular disease and stroke, weight, height, diabetes mellitus, creatinine, dialysis, hypertension, endocarditis, pulmonary disease, immunosuppression, previous cardiac surgery or angioplasty, use of preoperative inotropic, cardiogenic shock, cardiac resuscitation, cardiac arrhythmia, myocardial infarction, coronary symptoms, NYHA functional class, number of coronary arteries involved, LMCD lesion, LV ejection fraction, associated valvular heart disease, number of previous surgeries, procedure status (elective, urgent, emergent), use of intra-aortic balloon.
Euroscl	Age, gender, COPD, peripheral vascular disease, neurological dysfunction, creatinine, endocarditis, previous cardiac surgery, preoperative critical state (use of preoperative inotropic support, cardiogenic shock, cardiac resuscitation, use of intra-aortic balloon), unstable angina , recent myocardial infarction, left ventricular ejection fraction, pulmonary hypertension (PSAP greater than 60 mmHg), emergency, associated surgery, aortic surgery, post-infarction VSD.
Eurosc2	Age, gender, creatinine clearance, peripheral vascular disease, poor mobility, endocarditis, previous cardiac surgery, COPD, critical condition (use of preoperative inotropic, cardiogenic shock, cardiac resuscitation, use of intra-aortic balloon pump), insulin diabetes dependent, NYHA functional class, CCS angina classification, previous myocardial infarction, left ventricular ejection fraction, degree of pulmonary hypertension, procedure status (elective, urgent, emergent), associated surgery, aortic surgery.
InsCor	Age over 70 years, female gender, associated surgery (coronary + valve), recent infarction, reoperation, aortic valve surgery, tricuspid valve surgery, creatinine greater than 2 mg/dl, LV ejection fraction less than 30%, preoperative events (use of preoperative inotropic support, cardiogenic shock, cardiac resuscitation, use of intra-aortic balloon, acute renal failure, cardiac massage, tracheal intubation, tachycardia or ventricular fibrillation).