Prediction of Postoperative Cardiac Surgery Outcomes With a Novel Score: R2 CHADS2

Abstract Objective To compare the accuracy of R2CHADS2, CHADS2 and CHA2DS2-VASc scores versus the Society of Thoracic Surgeons (STS) score as predictors of morbidity and mortality after cardiovascular surgery. Methods All patients who underwent cardiothoracic surgery at our institution from January 2008 to July 2013 were analyzed. We included patients for whom the STS score could be calculated. The R2CHADS2 score was computed as follows: 2 points for GFR < 60 ml/min/m2 (R2), prior stroke, or TIA (S2); 1 point for history of congestive heart failure (C), hypertension (H), age >75 (A), or diabetes (D). Area under the curve (AUC) analysis was used to estimate the accuracy of the different schemes. The end point variables included operative mortality, permanent stroke, and renal failure as defined by the STS database system. Results Of the 3,492 patients screened, 2,263 met the inclusion criteria. These included 1,160 (51%) isolated valve surgery, 859 (38%) coronary artery bypass graft surgery, and 245 (11%) combined procedures. There were 147 postoperative events. 75 (3%) patients had postoperative renal failure, 48 (2%) had operative mortality, and 24 (1%) had permanent stroke. AUC analysis revealed that STS, R2CHADS2, CHADS2, and CHA2DS2- VASc reliably estimated all postoperative outcomes. STS and R2CHADS2 had the best accuracy overall, with no significant difference in AUC values between them. Conclusion The R2CHADS2 score estimates postoperative events with acceptable accuracy and if validated can be used as a simple preoperative drisk tool calculator.