PEACH score predicts mortality risk in ACHD after cardiac surgery

Researchers have recently developed and validated a simple perioperative risk score—Perioperative ACHD (PEACH)—for adult congenital heart disease (ACHD) patients undergoing surgery.

The study evaluated the performance of EuroSCORE II components and procedure-related Adult Congenital Heart Surgery (ACHS) score, identified additional risk factors, and developed a novel risk score for predicting in-hospital mortality after ACHD surgery.

Researchers assessed perioperative survival in patients aged >16 years undergoing congenital heart surgery in a large tertiary centre between 2003 and 2019. They calculated a risk variable–derived PEACH score for each patient and undertook internal and external validation of the model, including testing in a validation cohort of patients operated in a second European ACHD centre.

The development cohort included 1,782 procedures performed during the study period, of which 897 (50.3 percent) were resternotomy. Thirty-one (1.7 percent) in-hospital deaths were recorded.

The PEACH score demonstrated excellent discrimination ability (area under the curve [AUC], 0.88, 95 percent confidence interval [CI], 0.83–0.94) and performed better than the ACHS score (AUC, 0.69, 95 percent CI, 0.6–0.78; p=0.0003).

A simple three-tiered risk stratification was also generated: PEACH score 0 (in-hospital mortality 0.2 percent), 1–2 (3.6 percent), and ≥3 (17.2 percent).

In a validation cohort of 975 procedures, the PEACH score was consistent in its good discriminative ability (AUC, 0.75, 95 percent CI, 0.72–0.77) and was well calibrated (Hosmer-Lemeshow chi-square goodness-of-fit p=0.55).

Moreover, an agreement was noted in expected and observed perioperative mortality between cohorts.

“In-hospital mortality is a rare, yet feared complication following cardiac surgery in ACHD,” researchers said. “A risk score, developed and validated in ACHD, can be helpful to optimize risk assessment.”