SCiENTiFiC REpORtS | 7: 16806 | DOI:10.1038/s41598-017-16925-x
Validation of SinoSCORE for
isolated CABG operation in East
, Yunqian Wang
, Lingtong Shan
, Zhengqiang Cang
, Chang Gu
, Qifan Li
, Jun Li
, Zhenhua Wang
& Yangyang Zhang
From January 2010 to December 2016, 1616 consecutive patients who underwent isolated coronary
artery bypass grafting (CABG) were evaluated for their predicted mortality according to the online Sino
System for Coronary Operative Risk Evaluation (SinoSCORE), European System for Cardiac Operative
Risk Evaluation II (EuroSCORE II) and Society of Thoracic Surgeons (STS) risk evaluation system. The
calibration and discrimination in the total and in the subsets were assessed by the Hosmer-Lemeshow
(H-L) statistics and by the C statistics respectively, to evaluate the eciency of the three risk evaluation
systems. The realized mortality was 1.92% (31/1616). The predictive mortality of SinoSCORE,
EuroSCORE II and STS risk evaluation system were 1.35%, 1.74% and 1.05%, respectively. SinoSCORE
achieved best discrimination. When grouping by risk, SinoSCORE also achieved the best discrimination
in high-risk group, followed by STS risk evaluation system and EuroSCORE II while SinoSCORE and
EuroSCORE II had excellent performance in low-risk group. In terms of calibration, SinoSCORE,
EuroSCORE II and STS risk evaluation system all achieved positive calibrations (H-L: P > 0.05) in the
overall population and grouped subsets. SinoSCORE achieved good predictive eciency in East China
patients undergoing isolated CABG and showed no compromise when compared with EuroSCORE II and
STS risk evaluation system.
Coronary artery disease (CAD) is a common cardiovascular disease that seriously damages human health. Due to
the rapid economic development and higher incidence of CAD in developing countries, China has observed an
upsurge in patients undergoing CABG over the last decade
. e high risk of heart surgery during perioperation
has gradually come to the attention of surgeons. Several risk evaluation systems, which quantify the risk by the
patients’ data and predict their mortality or morbidity, have been developed and have received positive evalu-
ations during the last two decades worldwide. Of these systems, two have become predominant: EuroSCORE
in Europe and STS risk evaluation system in North America
. In China, Fuwai Hospital created a national
multi-center database of patients undergoing isolated CABG known as the Chinese Coronary Artery Bypass
Graing Registry Study
. Based on the more than 9,000 patients in this database, Sino System for Coronary
Operative Risk Evaluation (SinoSCORE) was published in 2010
SinoSCORE, EuroSCORE II and STS risk evaluation system were all developed using heart surgery patients
in dierent regions and were well received, to varying degrees, for clinical application. e aim of this study is to
validate SinoSCORE with isolated CABG patients in East China and compare the accuracy of predictive mortality
of the three systems.
For all 1616 patients in study, the realized mortality was 31 patients, or 1.92%. e baseline clinical characteristics
of total patients were summarised in Table1. e baseline data of subsets grouped by risk were shown in Table2
Research Center for Translational Medicine, East Hospital, Tongji University School of Medicine, Shanghai, China.
Key Laboratory of Arrhythmias of the Ministry of Education of China, East Hospital, Tongji University School of
Medicine, Shanghai, China.
The First Clinical Medical College of Nanjing Medical University, Nanjing, China.
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
of information technology, Shanghai Ocean University, Shanghai, China.
Department of Cardiovascular Surgery,
East Hospital, Tongji University School of Medicine, Shanghai, 200120, China. Xiue Ma, Yunqian Wang, Lingtong
Shan and Zhengqiang Cang contributed equally to this work. Correspondence and requests for materials should be
addressed to Z.W. (email: email@example.com) or Y.Z. (email: firstname.lastname@example.org)
Received: 17 July 2017
Accepted: 20 November 2017
Published: xx xx xxxx