Systematic review and meta-analysis of mortality risk prediction models in adult cardiac surgery

Shubhra Sinha, Arnaldo Dimagli, Lauren Dixon, Mario Gaudino, Massimo Caputo, Hunaid A Vohra, Gianni Angelini, Umberto Benedetto

Research output: Contribution to journalArticle (Academic Journal)peer-review

7 Citations (Scopus)
34 Downloads (Pure)


OBJECTIVES: The most used mortality risk prediction models in cardiac surgery are the European System for Cardiac Operative Risk Evaluation (ES) and Society of Thoracic Surgeons (STS) score. There is no agreement on which score should be considered more accurate nor which score should be utilized in each population subgroup. We sought to provide a thorough quantitative assessment of these 2 models.

METHODS: We performed a systematic literature review and captured information on discrimination, as quantified by the area under the receiver operator curve (AUC), and calibration, as quantified by the ratio of observed-to-expected mortality (O:E). We performed random effects meta-analysis of the performance of the individual models as well as pairwise comparisons and subgroup analysis by procedure type, time and continent.

RESULTS: The ES2 {AUC 0.783 [95% confidence interval (CI) 0.765-0.800]; O:E 1.102 (95% CI 0.943-1.289)} and STS [AUC 0.757 (95% CI 0.727-0.785); O:E 1.111 (95% CI 0.853-1.447)] showed good overall discrimination and calibration. There was no significant difference in the discrimination of the 2 models (difference in AUC -0.016; 95% CI -0.034 to -0.002; P = 0.09). However, the calibration of ES2 showed significant geographical variations (P < 0.001) and a trend towards miscalibration with time (P=0.057). This was not seen with STS.

CONCLUSIONS: ES2 and STS are reliable predictors of short-term mortality following adult cardiac surgery in the populations from which they were derived. STS may have broader applications when comparing outcomes across continents as compared to ES2.

REGISTRATION: Prospero ( CRD42020220983.

Original languageEnglish
Pages (from-to)673-686
Number of pages14
JournalInteractive Cardiovascular and Thoracic Surgery
Issue number5
Early online date26 May 2021
Publication statusPublished - 23 Oct 2021

Bibliographical note

Publisher Copyright:
© 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.


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