The Impact of EuroSCORE II Risk Factors on Prediction of Long-Term Mortality Fabio Barili, MD, PhD, Davide Pacini, MD, Mariangela D’Ovidio, MS, Nicholas.

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The Impact of EuroSCORE II Risk Factors on Prediction of Long-Term Mortality Fabio Barili, MD, PhD, Davide Pacini, MD, Mariangela D’Ovidio, MS, Nicholas C. Dang, MD, Francesco Alamanni, MD, Roberto Di Bartolomeo, MD, Claudio Grossi, MD, Marina Davoli, PhD, Danilo Fusco, PhD, Alessandro Parolari, MD, PhD The Annals of Thoracic Surgery Volume 102, Issue 4, Pages 1296-1303 (October 2016) DOI: 10.1016/j.athoracsur.2016.04.017 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Performance of European System for Cardiac Operative Risk Evaluation (EuroSCORE) II in predicting (A) inhospital, (B) 30-day, (C) 1-year, and (D) 5-year mortality. AUC are shown in left-hand panels, calibration plots are shown in right-hand panels. The area under the curve (AUC) significantly decreases in 1-year and 5-year predictions. Even calibration plots were similar for inhospital death and 30-day death, demonstrating optimal performance until 20% to 30% predicted mortality and a progressive overprediction afterward. On the contrary, there is constant miscalibration in prediction of both 1-year and 5-year mortality, with a pattern of marked underprediction. (CI = confidence interval; ROC = receiver-operating characteristic.) The Annals of Thoracic Surgery 2016 102, 1296-1303DOI: (10.1016/j.athoracsur.2016.04.017) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Kaplan-Meier estimates of survival of the study cohort. Survival rates at 1 year, 5 years, and 9 years were, respectively, 95.0% ± 0.2%, 84.7% ± 0.4%, and 67.6% ± %1.2%. (B) Kaplan-Meier estimates of long-term survival of patients classified within deciles of European System for Cardiac Operative Risk Evaluation (EuroSCORE) II. A significant relationship between deciles of EuroSCORE II survival is evident (log rank test p < 0.0001). The Annals of Thoracic Surgery 2016 102, 1296-1303DOI: (10.1016/j.athoracsur.2016.04.017) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Nonlinear relationship between hazard ratio of death and European System for Cardiac Operative Risk Evaluation (EuroSCORE) II values in the bivariate Cox model. The hazard ratio increases highly until 5% predicted perioperative mortality, whereas its increase was continuous but less marked afterward. The Annals of Thoracic Surgery 2016 102, 1296-1303DOI: (10.1016/j.athoracsur.2016.04.017) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Effect on survival time ratio of the risk factors selected in the final model. (NYHA = New York Heart Association; yrs = years.) The Annals of Thoracic Surgery 2016 102, 1296-1303DOI: (10.1016/j.athoracsur.2016.04.017) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Prediction of survival of three different European System for Cardiac Operative Risk Evaluation (EuroSCORE) II risk profiles. As evident, the survival curves are consistent with the preoperative predicted mortality; nonetheless, the effects of singular risk factors are different on short-term and long-term outcomes. (COPD = chronic obstructive pulmonary disease; EF = ejection fraction; yrs = years.) The Annals of Thoracic Surgery 2016 102, 1296-1303DOI: (10.1016/j.athoracsur.2016.04.017) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions