Original European System For Cardiac Operative Risk Evaluation Research Articles

EuroSCORE Performance in Minimally Invasive Cardiac Surgery: Discrimination Ability and External Calibration.

Prediction of operative risk in adults undergoing cardiac surgery remains a challenge. The European System for Cardiac Operative Risk Evaluation (EuroSCORE) is one of the most commonly used in clinical settings. Recently, the new EuroSCORE II was published attempting to improve the accuracy of risk prediction. We sought to assess the predictive value of EuroSCORE or EuroSCORE II in selected field of minimally invasive cardiac surgery. Patients who underwent cardiac surgery operation with minimally invasive approach from 2007 to 2013 identified from prospective cardiac surgical database. Additional variables included in EuroSCORE II, but not in original EuroSCORE, were retrospectively collected via electronic health records reviewing. The C-statistic was calculated for the EuroSCORE (additive and logistic) and EuroSCORE II. The Hosmer-Lemeshow test was used to assess model calibration by comparing observed and expected morality in number of risk strata. There were 39 hospitals deaths (1.6%). A total of 2472 patients were identified from the main database. The mean ± SD logistic EuroSCORE was 7.6 ± 8.3, mean ± SD additive EuroSCORE was 6.1 ± 2.7, and mean ± SD EuroSCORE II was 2.9 ± 4.2. EuroSCORE logistic model performed with substantial accuracy of 0.78, EuroSCORE additive performed with accuracy of 0.78, and EuroSCORE II performed as almost perfect 0.82. Model calibration was poor in EuroSCORE II (χ = 17.57, P = 0.02), calibration for logistic EuroSCORE was also poor (χ = 140.58, P < 0.01), and additive model also (χ = 94.95, P < 0.01). The area under the curve was high in all algorithms; logistic EuroSCORE was 0.78 (95% confidence interval = 0.71-0.85), additive EuroSCORE was 0.79 (95% confidence interval = 0.71-0.86), and EuroSCORE II was 0.82 (95% confidence interval = 0.75-0.89). In overall settings, original EuroSCORE and EuroSCORE II perform poorly in minimally invasive operation conditions. Data suggest that EuroSCORE could not be used for estimating operative risks correctly. New risk score should be explored, developed, and implemented for selective minimally invasive cohorts.

Comparison of EuroSCORE II, Original EuroSCORE, and The Society of Thoracic Surgeons Risk Score in Cardiac Surgery Patients

The European System for Cardiac Operative Risk Evaluation (EuroSCORE) II was developed to reflect a more current dataset and evidence-based improvements in cardiac surgery. In the United States, The Society of Thoracic Surgeons (STS) risk score is more accepted owing to relatively high predictive value despite less user friendliness and inapplicability to some cardiac surgeries. We compared the precision of EuroSCORE II with EuroSCORE I and the STS risk score for operative mortality. Data were collected prospectively for all cardiac surgery patients at a single center since 2001 (N= 11,788). A secondary analysis for patients with cardiac surgery not accommodated by the STS model compared only EuroSCORE II and I (N= 5,880). Receiver-operating characteristic analyses were performed for operative mortality to determine the discriminative ability for each score. Observed operative mortality was 1.8%. Mean predicted mortality for STS risk score, EuroSCORE II, and EuroSCORE I was 2.7%, 3.3%, and 7.8%, respectively. The discriminative ability for operative mortality by area under the curve for EuroSCORE II, EuroSCORE I, and STS risk score was 0.844, 0.819, and 0.846, respectively. In secondary analyses comparing EuroSCORE II with EuroSCORE I, risk scores were correlated (rs= 0.83, p < 0.001). However, for operative mortality (observed, 4%), EuroSCORE II had better absolute prediction and discriminative ability (expected, 5.8%; area under the curve 0.754) than EuroSCORE I (expected, 12.5%; area under the curve 0.688). EuroSCORE II had better predictive discrimination for operative mortality than EuroSCORE I, which greatly overestimated this risk. EuroSCORE II fared well compared with the STS risk score. The inclusive nature of EuroSCORE II for numerous procedures provides more flexibility than the STS score for complex procedures. EuroSCORE II should be considered for calculating risk score for complex cardiac surgical patients.

Limitations of EuroSCORE for Measurement of Risk-Stratified Mortality in Aortic Arch Surgery Using Selective Cerebral Perfusion: Is Advanced Age No Longer a Risk?

The European system for cardiac operative risk evaluation (EuroSCORE) is a risk stratification tool for perioperative mortality of cardiothoracic surgery that was developed in Europe and validated in North America in more than 500,000 patients. The operative mortality of aortic arch surgery has been improved by various novel operative techniques and adjuncts, whereas the number of such procedures for elderly patients has recently been increasing. The aim of this study was to examine the usefulness of the EuroSCORE, and our modification of it regarding age, in predicting mortality after aortic arch repair performed with selective cerebral perfusion. We reviewed 358 consecutive patients with a mean age of 69 +/- 10 years undergoing aortic arch repair with selective cerebral perfusion between January 1993 and February 2004. Observed in-hospital mortality was compared with predicted mortality as determined by both additive and logistic EuroSCOREs. We also evaluated a version of the EuroSCORE modified for age, which was obtained by subtracting the contribution of age from the original EuroSCORE. Score validities were assessed by calculating the areas under receiver operating characteristic curves. Overall hospital mortality was 6.2% compared with 7.7% (additive EuroSCORE) and 11.8% (logistic EuroSCORE). Area under the receiver operating characteristic curve was 0.58 for the additive EuroSCORE and 0.58 for the logistic EuroSCORE as well. The overall age-unrelated EuroSCOREs were 5.1% (additive) and 5.2% (logistic), respectively, and areas under the receiver operating characteristic curve were 0.70 for additive and 0.69 for logistic. The original additive and logistic EuroSCOREs overpredicted mortality in this patient group, whereas the age-unrelated EuroSCORE was better in predicting mortality.