Article Text

East meets West: the influence of racial, ethnic and cultural risk factors on cardiac surgical risk model performance
  1. Sarah Soo-Hoo,
  2. Samantha Nemeth,
  3. Onur Baser,
  4. Michael Argenziano,
  5. Paul Kurlansky
  1. Department of Surgery, Columbia University, New York, New York City, USA
  1. Correspondence to Dr Paul Kurlansky, Department of Surgery, Columbia University Medical Center, New York NY 10032, USA; pk2245{at}


Objective To explore the impact of racial and ethnic diversity on the performance of cardiac surgical risk models, the Chinese SinoSCORE was compared with the Society of Thoracic Surgeons (STS) risk model in a diverse American population.

Methods The SinoSCORE risk model was applied to 13 969 consecutive coronary artery bypass surgery patients from twelve American institutions. SinoSCORE risk factors were entered into a logistic regression to create a ‘derived’ SinoSCORE whose performance was compared with that of the STS risk model.

Results Observed mortality was 1.51% (66% of that predicted by STS model). The SinoSCORE ‘low-risk’ group had a mortality of 0.15%±0.04%, while the medium-risk and high-risk groups had mortalities of 0.35%±0.06% and 2.13%±0.14%, respectively. The derived SinoSCORE model had a relatively good discrimination (area under of the curve (AUC)=0.785) compared with that of the STS risk score (AUC=0.811; P=0.18 comparing the two). However, specific factors that were significant in the original SinoSCORE but that lacked significance in our derived model included body mass index, preoperative atrial fibrillation and chronic obstructive pulmonary disease.

Conclusion SinoSCORE demonstrated limited discrimination when applied to an American population. The derived SinoSCORE had a discrimination comparable with that of the STS, suggesting underlying similarities of physiological substrate undergoing surgery. However, differential influence of various risk factors suggests that there may be varying degrees of importance and interactions between risk factors. Clinicians should exercise caution when applying risk models across varying populations due to potential differences that racial, ethnic and geographic factors may play in cardiac disease and surgical outcomes.

  • surgery-coronary bypass
  • risk stratification
  • epidemiology
  • research methods

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  • Contributors All authors participated in the analysis of the data and either manuscript writing or review.

  • Funding Funding for this project was supplied by entirely unrestricted internal funds from the Department of Surgery of Columbia University.

  • Disclaimer None of the authors has any conflict to disclose regarding any aspect of this work; all views expressed are those of the authors, not an official position of the Department of Surgery nor of the University.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Columbia University Human Subjects Protocol AAAQ2103.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Presented at Presented at the 2016 Scientific Sessions of the American Heart Association, New Orleans, 14 November 2016.

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