Abstract 12044: East Meets West in the Assessment of Cardiac Risk: A Multicenter Comparative Study of the Influence of Racial, Ethnic and Cultural Risk Factors on Cardiac Surgical Risk Model Performance

Abstract

Introduction: Numerous risk models have been applied to coronary artery bypass (CABG) patients. Their applicability across racial, ethnic and cultural backgrounds has not been well-described. We therefore compared the performance of the SinoSCORE, derived from 43 Chinese medical centers (c-statistic=0.80), with the Society of Thoracic Surgeons (STS) CABG mortality risk model in a population of CABG patients from a diverse multicenter American registry. Hypothesis: Racial, ethnic and cultural differences will impact the performance of surgical risk models. Methods: Perioperative data on all patients undergoing CABG between May 2006 and December 2015 from each of 8 centers was entered into the STS database. SinoSCORE and STS predicted risk of mortality was calculated for each patient. Logistic regression was used to develop a risk model based on SinoSCORE variables and performance was compared to STS risk model. Results: 7918 patients underwent CABG of whom 1.36% % were Asian. Sino-SCORE successfully categorized surgical mortality into low (0.12%), medium (0.36%) and high (2.42%) risk of mortality. However, the discrimination and calibration was better for STS than for the derived SinoSCORE (c-statistic 0.8087 vs. 0.767; p=0.0007; Figure; Hosemer-Lemeshow χ 2 52.64 vs. 40.05). Moreover, several of the factors which were predictors of mortality in the original SinoSCORE (age 65-70, BMI<18, chronic renal insufficiency, extracardiac arteriopathy, COPD, atrial fibrillation, urgent status) were not predictors in the derived model when applied to this multicenter Western patient population Conclusions: A CABG risk model derived from a from a broad sampling of Chinese patients did not perform as well in a diverse multicenter American population as it did in the population of origin, or as did the STS risk model. Considerable caution should be exercised, even for common operations, in applying surgical risk models across racial, ethnic and cultural divisions.