Coronary interventions

Prognostic performance of the Society of Thoracic Surgeons risk score in patients with left main coronary artery disease undergoing revascularisation: a post hoc analysis of the EXCEL trial

EuroIntervention 2020;16:36-43. DOI: 10.4244/EIJ-D-19-00417

Daniel Thuijs
Daniel J.F.M. Thuijs1, DMSc; Robert H. Habib2, PhD; Stuart J. Head1, MD, PhD; John D. Puskas3, MD; David P. Taggart4, MD, PhD; Gregg W. Stone5,6, MD; Zixuan Zhang5, MS; Patrick W. Serruys7, MD, PhD; Joseph F. Sabik 3rd8, MD; A. Pieter Kappetein1, MD, PhD
1. Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands; 2. Society of Thoracic Surgeons Research Center, Chicago, IL, USA; 3. Department of Cardiovascular Surgery, Mount Sinai Heart at Mount Sinai Saint Luke's, New York, NY, USA; 4. Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom; 5. Clinical Trials Centre, Cardiovascular Research Foundation, New York, NY, USA; 6. Center for Interventional Vascular Therapy, Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Centre, New York, NY, USA; 7. Imperial College of Science, Technology and Medicine, London, United Kingdom; 8. Department of Surgery, University Hospitals Cleveland Medical Centre, Cleveland, OH, USA

Aims: Accurate risk prediction in patients undergoing revascularisation is essential. We aimed to assess the predictive performance of Society of Thoracic Surgeons (STS) risk models in patients with left main coronary artery disease (LMCAD) undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention with everolimus-eluting stents (PCI-EES).

Methods and results: The predictive performance of STS risk models for perioperative mortality, stroke and renal failure was evaluated for their discriminative ability (C statistic) and calibration (Hosmer-Lemeshow goodness-of-fit-test; χ2 and p-values) among patients with LMCAD undergoing PCI-EES (n=935) and CABG (n=923) from the randomised EXCEL trial. STS risk scores, in CABG patients, showed good discrimination for 30-day mortality and average discrimination for stroke (C statistic 0.730 and 0.629, respectively) with average calibration. For PCI, STS risk scores had no discrimination for mortality (C statistic 0.507), yet good discrimination (C statistic 0.751) and calibration for stroke. The predictive performance for renal failure was good for CABG (C statistic 0.82), yet poor for PCI (C statistic 0.59).

Conclusions: In selected patients with LMCAD from the EXCEL trial, STS risk models showed good predictive performance for CABG yet lacked predictive performance for PCI for perioperative mortality and renal failure. The STS stroke risk model was surprisingly more discriminating in PCI compared to CABG. Improved and procedure-specific risk prediction instruments are needed to accurately estimate adverse events after LMCAD revascularisation by CABG and PCI. Identifier: NCT01205776

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clinical trialsdeathdrug-eluting stentrevascularisationrisk stratificationstroke
Coronary interventionsStable CADStents and scaffoldsLeft main and multivessel disease
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