Tehran University Medical Journal

Background: Various prediction models have been developed aiming to estimate risk-adjusted mortality, morbidity and length of intensive care unit stay following cardiac surgeries. The European system for cardiac operative risk evaluation II (EuroSCORE II) is a prediction model which maps 18 predictors to a 30-day post-operative risk of death. The objective of this study was to evaluate the performance of the EuroSCORE II risk-analysis predictions among patients who underwent heart surgeries.
Methods: A prospective cross-sectional study was conducted to collect required variables for all consecutive patients underwent heart surgeries in Emam Reza hospital, Mashhad, Iran, from March 2014 to March 2015. Once the patient was hospitalized a cardiologist or a general physician evaluated pre- peri- and post-operative state to fill out the pre-designed structural paper form. Comparing the observed and expected mortality, the sensitivity, specificity, area under the receiver operating characteristic curve (AUC) and finally the discrimination power of the model for our patients were calculated and reported. The model value was calculated using the online tool.
Results: A total of 1337 patients (60% males) were included, the observed mortality rate was 3.2%. Although the overall performance was acceptable, the model showed poor discriminatory power (AUC=0.667, CI 95%: 0.648-0.685) and accuracy with sensitivity=61.88% and specificity=66.23%.
Conclusion: Our single-center study, based on consecutive patients who underwent cardiac surgery showed that EuroSCORE II demonstrated a moderate statistical overall performance with poor discrimination and calibration measures remain as concerning issues regarding 30-day post-operative mortality prediction after adult cardiac surgery. Poor performance measures for this system show the need for reformulating this risk stratification tool aiming to improve post cardiac surgery outcome predictions in Iran.

Background: Acute coronary syndrome (ACS) is one of the causes of disability and death. Levels of Uric acid, blood glucose, and dyslipidemia are the risk factors for the disease, but their role in electrocardiographic changes has not been studied. Based on this, this study aimed to investigate the relationship between some demographic and clinical characteristics with electrocardiographic changes.
Methods: This cross-sectional study was performed on 484 patients with Acute Coronary Syndrome admitted to Shahroud Imam Hossein Hospital from the beginning of January to the end of June 2018. In this study, the relationship between demographic, clinical and laboratory variables in patients with the acute coronary syndrome with STE, STD, Dynamic changes and inverted T waves were investigated. The required information was extracted from the Patients' records using the researcher-made checklist. Statistical analysis of data was conducted by using descriptive tests for estimating mean and frequency and statistical-analytical tests including chi-square and ANOVA were performed by SPSS software version 22.
Results: The results show that the proportion of STD deviations in women with ACS was 12.6% higher than in men, but the proportion of STE and Dynamic changes in men was 10.4% and 12.2% higher than women, respectively. The proportion of STD, STE, inverted T and Dynamic changes in people with hyperlipidemia was 67.8%, 77.6%, 64.7% and 75.8%, respectively. The proportion of STD, STE, inverted T and Dynamic changes in patients with hypertension were 0.12%, 5.1%, 11.2%, and 19.1%, respectively that there was a difference with patients without high blood pressure. Between addiction, fasting blood sugar and LDL with STD; Between History of heart disease, history of angiography, hypertension, creatinine and WBC with STE; and between creatinine and fasting blood sugar statistically significant differences were observed.