Validation of European System for Cardiac Operative Risk Evaluation (EuroSCORE) in North American cardiac surgery (original) (raw)
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European Journal of Cardio-Thoracic Surgery, 2014
OBJECTIVES: To evaluate performance of the European System for Cardiac Operation Risk Evaluation (EuroSCORE II), to assess the influence of model updating and to derive a hierarchical tree for modelling the relationship between EuroSCORE II risk factors and hospital mortality after cardiac surgery in a large prospective contemporary cohort of consecutive adult patients. METHODS: Data on consecutive patients, who underwent on-pump cardiac surgery or off-pump coronary artery bypass graft intervention, were retrieved from Puglia Adult Cardiac Surgery Registry. Discrimination, calibration, re-estimation of EuroSCORE II coefficients and hierarchical tree analysis of risk factors were assessed. RESULTS: Out 6293 procedures, 6191 (98.4%) had complete data for EuroSCORE II assessment with a hospital mortality rate of 4.85% and EuroSCORE II of 4.40 ± 7.04%. The area under the receiver operator characteristic curve (0.830) showed good discriminative ability of EuroSCORE II in distinguishing patients who died and those who survived. Calibration of EuroSCORE II was preserved with lower predicted than observed risk in the highest EuroSCORE II deciles. At logistic regression analysis, the complete revision of the model had most of reestimated regression coefficients not statistically different from those in the original EuroSCORE II model. When missing values were replaced with the mean EuroSCORE II value according to urgency and weight of intervention, the risk score confirmed discrimination and calibration obtained over the entire sample. A recursive tree-building algorithm of EuroSCORE II variables identified three large groups (55.1, 17.1 and 18.1% of procedures) with low-to-moderate risk (observed mortality of 1.5, 3.2 and 6.4%) and two groups (3.8 and 5.9% of procedures) at high risk (mortality of 14.6 and 32.2%). Patients with low-to-moderate risk had good agreement between observed events and predicted frequencies by EuroSCORE II, whereas those at greater risk showed an underestimation of expected mortality. CONCLUSIONS: This study demonstrates that EuroSCORE II is a good predictor of hospital mortality after cardiac surgery in an external validation cohort of contemporary patients from a multicentre prospective regional registry. The EuroSCORE II predicts hospital mortality with a slight underestimation in high-risk patients that should be further and better evaluated. The EuroSCORE II variables as a risk tree provides clinicians and surgeons a practical bedside tool for mortality risk stratification of patients at low, intermediate and high risk for hospital mortality after cardiac surgery.
The Annals of Thoracic Surgery, 2004
Methods. Risk factors for all adult patients undergoing heart surgery at the University Hospital of Lund between 1996 and 2001 were collected prospectively at preoperative admission. Predictive accuracy for 30-day mortality was assessed by comparing the observed and the expected mortality for equal-sized quintiles of risk by using the Hosmer-Lemeshow goodness-of-fit test. The discriminatory power was evaluated by calculating the areas under receiver operating characteristics (ROC) curves.
EuroSCORE overestimates the cardiac operative risk
Cardiovascular Surgery, 2003
information on risk factors and mortality was collected for 1123 consecutive adult patients undergoing heart surgery with cardiopulmonary bypass. EuroSCORE was used for risk stratification. Mean age ± standard deviation was 58.6 ± 10.9 and 29.1% of the patients were female. The area under the receiver operating characteristic (ROC) curve was calculated as an index for the predictive value of the scoring system.
Comparison of 19 pre-operative risk stratification models in open-heart surgery
European Heart Journal, 2006
Aims To compare 19 risk score algorithms with regard to their validity to predict 30-day and 1-year mortality after cardiac surgery. Methods and results Risk factors for patients undergoing heart surgery between 1996 and 2001 at a single centre were prospectively collected. Receiver operating characteristics (ROC) curves were used to describe the performance and accuracy. Survival at 1 year and cause of death were obtained in all cases. The study included 6222 cardiac surgical procedures. Actual mortality was 2.9% at 30 days and 6.1% at 1 year. Discriminatory power for 30-day and 1-year mortality in cardiac surgery was highest for logistic (0.84 and 0.77) and additive (0.84 and 0.77) European System for Cardiac Operative Risk Evaluation (EuroSCORE) algorithms, followed by Cleveland Clinic (0.82 and 0.76) and Magovern (0.82 and 0.76) scoring systems. None of the other 15 risk algorithms had a significantly better discriminatory power than these four. In coronary artery bypass grafting (CABG)-only surgery, EuroSCORE followed by New York State (NYS) and Cleveland Clinic risk score showed the highest discriminatory power for 30-day and 1-year mortality. Conclusion EuroSCORE, Cleveland Clinic, and Magovern risk algorithms showed superior performance and accuracy in open-heart surgery, and EuroSCORE, NYS, and Cleveland Clinic in CABG-only surgery. Although the models were originally designed to predict early mortality, the 1-year mortality prediction was also reasonably accurate.
European Journal of Cardio-thoracic Surgery, 2004
Objective: To study the use of the additive and logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) to predict mortality following adult combined coronary artery bypass grafting (CABG) and valve surgery. Methods: Data were collected prospectively, from all four centres providing adult cardiac surgery in the north west of England, on 1769 consecutive patients undergoing combined CABG and valve surgery between April 1997 and March 2002. Observed in-hospital mortality was compared to predicted mortality as determined by both additive and logistic EuroSCORE. Results: Observed mortality for simultaneous CABG and valve surgery was 8.7%, compared to 6.7% (additive) and 9.4% (logistic). Sixty-five percent of patients were classified as high-risk (additive EuroSCORE .5); the observed mortality was 11.5%, compared to 8.1% (additive) and 12.8% (logistic). Discrimination was similar in both systems as measured by the C statistic (additive 0.73, logistic 0.73). Conclusions: The logistic EuroSCORE is more accurate at predicting mortality in simultaneous CABG and valve surgery, as the additive EuroSCORE significantly under-predicts in this high-risk group. q
European Journal of Cardio-thoracic Surgery, 2000
Objective: To compare the national samples of patients who underwent isolated coronary artery bypass grafting (CABG) during the European System for Cardiac Operative Risk Evaluation (EuroSCORE) trial in order to evaluate national differences in epidemiology, patient risk pro®le and surgical methods. Methods: From September to November 1995, 11 731 patients had CABG in the six largest contributing nations to the EuroSCORE project: Germany, UK, Spain, Finland, France and Italy. The Chi-square and Kruskal±Wallis tests were applied to obtain an international comparison of patient general status, including pre-operative risk factors, cardiac status, critical preoperative states, rare conditions, urgency of surgery, angina status, coronary lesions, procedures and EuroSCORE risk assessment. Results: Large national samples (from 984 patients in Finland to 3138 in Germany) identi®ed signi®cant differences in epidemiology, risk pro®le and surgical practice. Regarding epidemiology, CABG accounted for 62.8% of adult cardiac surgery, with a range of 46.2 in Spain to 77.7% in Finland (P , 0:001). The mean age was 62.9 years (61.4 in Britain to 64.4 in France, P , 0:001). The mean body mass index was 26.8 (26 in France to 27.5 in Finland, P , 0:001). With regard to risk pro®le, diabetes was present in 20.3% of patients (11.8% in Britain to 27.7% in Spain, P , 0:001). Chronic renal failure was present in 8.3% (6.8% in Germany to 10.6% in Spain, P , 0:001). Chronic airway disease affected 3.8% (1.9% in Italy to 5.1% in Germany, P , 0:001). The mean ejection fraction was 0.56 (0.48 in Britain to 0.58 in Finland, P , 0:001). The mean predicted mortality (according to EuroSCORE) was 3.3% (2.8% in Finland to 3.6% in France, P , 0:001). The prevalence of chronic congestive heart failure, unstable angina and recent myocardial infarction also showed statistically signi®cant differences. No differences were found for some critical preoperative states (such as immediate preoperative cardiac massage and preoperative intubation), or for surgery for catheter laboratory complication. Regarding surgical practice, major differences were noted in preoperative intra-aortic balloon use (mean 1%, Finland 0%, Spain 2.3%, P , 0:001), the number of mammary artery conduits used (mean 0.9, Spain 0.7, France 1.1, P 0:0001) and the number of distal anastomoses (mean 3, France 2.7, Finland 3.8, P 0:001). Conclusion: There are important epidemiological differences in the national cohorts of CABG patients in the EuroSCORE database. Any international comparison of European surgical results must therefore take into account the risk pro®le of patients by using a compatible risk strati®cation system. q
The logistic EuroSCORE in cardiac surgery: how well does it predict operative risk?
Heart, 2006
Objectives: To study the ability of the logistic EuroSCORE to predict operative risk in contemporary cardiac surgery. Design: Retrospective analysis of prospectively collected data. Setting: All National Health Service centres undertaking adult cardiac surgery in northwest England. Patients: All patients undergoing cardiac surgery between April 2002 and March 2004. Main outcome measures: The predictive ability of the logistic EuroSCORE was assessed by analysing how well it discriminates between patients with differing observed risk by using the area under the receiver operating characteristic (ROC) curve and studying how well it is calibrated against observed in-hospital mortality. The performance of the EuroSCORE was examined in the following surgical subgroups: all cardiac surgery, isolated coronary artery surgery, isolated valve surgery, combined valve and coronary surgery, mitral valve surgery, aortic valve surgery and other surgery. Results: 9995 patients underwent surgery. The discrimination of the logistic EuroSCORE was good with a ROC curve area of 0.79 for all cardiac surgery (range 0.71-0.79 in the subgroups). For all operations, the predicted mortality was 5.7% and observed mortality was 3.3%. The logistic EuroSCORE overpredicted observed mortality for all subgroups but by differing degrees (p = 0.02) Conclusions: The logistic EuroSCORE is a reasonable overall predictor for contemporary cardiac surgery but overestimates observed mortality. Its accuracy at predicting risk in different surgical subgroups varies. The logistic EuroSCORE should be recalibrated before it is used to gain reassurance about outcomes. Caution should be exercised when using it to compare hospitals or surgeons with a different operative case mix. 1817 www.heartjnl.com
Netherlands Heart Journal, 2010
Background. Risk-adjusted mortality rates are used to compare quality of care of different hospitals. We evaluated the EuroSCORE (European System for Cardiac Operative Risk Evaluation) in patients undergoing isolated coronary artery bypass grafting (CABG). Patients and method. Data of all CABG patients from January 2004 until December 2008 were analysed. Receiver-operating characteristics (ROC) curves for the additive and logistic Euro SCOREs and the areas under the ROC curve were calculated. Predicted probability of hospital mortality was calculated using logistic regression analyses and compared with the EuroSCORE. Cumulative sum (CUSUM) analyses were performed for the EuroSCORE and the actual hospital mortality. Results. 5249 patients underwent CABG of which 89 (1.7%) died. The mean additive EuroSCORE was 3.5±2.5 (0-17) (median 3.0) and the mean logistic EuroSCORE was 4.0±5.5 (0-73) (median 2.4). The area under the ROC curve was 0.80±0.02 (95% confidence interval (CI) 0.76 to 0.84) for the additive and 0.81±0.02 (0.77 to 0.85) for the logistic EuroSCORE. The predicted probability (hazard ratio) was different from the additive and logistic EuroSCOREs. The hospital mortality was half of the EuroSCOREs, resulting in positive variable life-adjusted display curves. Conclusions. Both the additive and logistic Euro SCOREs are overestimating the in-hospital mortality risk in low-risk CABG patients. The logistic EuroSCORE is more accurate in high-risk patients compared with the additive EuroSCORE. Until a more accurate risk scoring system is available, we suggest being careful when comparing the quality of care of different centres based on risk-adjusted mortality rates.
Vojnosanitetski pregled
Background/Aim. The treshold that defines a low, moderate or high-risk patients is not uniformly determined for the European System for Cardiac Operative Risk Evaluation (EuroSCORE II) by literature at present. The aim of this study was to suggest risk groups categorization within EuroSCORE II risk statification model. Methods. A 7,641 consecutive patients were scored preoperatively using EuroSCORE II. The end point for the study was in-hospital mortality accross the risk group categories. Patients with EuroSCORE II values of ? 2.50, > 2.50?6.50%, and > 6.50% were defined to be at low, moderate, and high perioperative risk, respectively. Discriminative power of the model was tested by calculating the area under the receiver operating characteristic curve (AUC). The calibration of the model was assessed by Hosmer-Lemeshow statistics, and with observed/expected (O/E) mortality ratio. Results. Inhospital mortality observed in our sample was 3.85% (295 out of 7,641 patients). The ...
European Journal of Cardio-thoracic Surgery, 1999
Objective: To assess risk factors for mortality in cardiac surgical adult patients as part of a study to develop a European System for Cardiac Operative Risk Evaluation (EuroSCORE). Methods: From September to November 1995, information on risk factors and mortality was collected for 19030 consecutive adult patients undergoing cardiac surgery under cardiopulmonary bypass in 128 surgical centres in eight European states. Data were collected for 68 preoperative and 29 operative risk factors proven or believed to in¯uence hospital mortality. The relationship between risk factors and outcome was assessed by univariate and logistic regression analysis. Results: Mean age (^standard deviation) was 62:5^10:7 (range 17±94 years) and 28% were female. Mean body mass index was 26:3^3:9. The incidence of common risk factors was as follows: hypertension 43.6%, diabetes 16.7%, extracardiac arteriopathy 2.9%, chronic renal failure 3.5%, chronic pulmonary disease 3.9%, previous cardiac surgery 7.3% and impaired left ventricular function 31.4%. Isolated coronary surgery accounted for 63.6% of all procedures, and 29.8% of patients had valve operations. Overall hospital mortality was 4.8%. Coronary surgery mortality was 3.4% In the absence of any identi®able risk factors, mortality was 0.4% for coronary surgery, 1% for mitral valve surgery, 1.1% for aortic valve surgery and 0% for atrial septal defect repair. The following risk factors were associated with increased mortality: age (P 0:001), female gender (P 0:001), serum creatinine (P 0:001), extracardiac arteriopathy (P 0:001), chronic airway disease (P 0:006), severe neurological dysfunction (P 0:001), previous cardiac surgery (P 0:001), recent myocardial infarction (P 0:001), left ventricular ejection fraction (P 0:001), chronic congestive cardiac failure (P 0:001), pulmonary hypertension (P 0:001), active endocarditis (P 0:001), unstable angina (P 0:001), procedure urgency (P 0:001), critical preoperative condition (P 0:001) ventricular septal rupture (P 0:002), noncoronary surgery (P 0:001), thoracic aortic surgery (P 0:001). Conclusion: A number of risk factors contribute to cardiac surgical mortality in Europe. This information can be used to develop a risk strati®cation system for the prediction of hospital mortality and the assessment of quality of care. q 1999 Elsevier Science B.V. All rights reserved.