Criteria for Using Risk Models in Cardiac Surgery

Few therapeutic interventions have been so widely researched, evaluated, and commented on as cardiac surgery, and in particular coronary revascularization. Aspects related to outcomes and the appropriateness of indications have, among many others, received much attention. This type of research is driven by many interest groups, including heart surgeons, cardiologists, epidemiologists, health care managers, health service providers, and the media. It is one of the few specialties in which outcome audits are mooted as soon as the alarm bells sound. Why has heart surgery been the object of such exhaustive analysis compared to other interventions? Although it is not the aim of this editorial to go into detail on this point, one of the reasons might be the interest shown by heart surgeons themselves in evaluating their own activities. Groups performing cardiac surgery have pioneered the introduction of predictive systems to estimate the risks associated with their surgical procedures. This has led to a culture centered around “risk” and riskassessment and it is nowadays common for heart surgeons and cardiologists to factor risk assessments into decision-making with their surgery patients. This is often done by employing risk assessment systems such as the EuroSCORE, Parsonnet, or STS.1-5 The 2004 AHA/ACC clinical guidelines6 suggest that preoperative predictive systems to assess risk can help both clinicians and patients to understand the risk-benefit equation for the procedure concerned (class IIa recommendation, level of evidence C). Criteria for Using Risk Models in Cardiac Surgery