Eur J Cardiothorac Surg 2002 Jul;22(1):101-5
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Validation of European System for Cardiac Operative Risk
Evaluation (EuroSCORE) in North American cardiac surgery.
Nashef SA, Roques F, Hammill BG, Peterson ED, Michel P, Grover FL, Wyse
RK, Ferguson TB.
Cardiothoracic Surgical Unit, Papworth Hospital, Papworth Everard, Cambridge
CB3 8RE, UK
OBJECTIVE: To assess the performance of the European System for Cardiac
Operative Risk Evaluation (EuroSCORE) when applied in a North American cardiac
surgical population. METHODS: The simple additive EuroSCORE model was applied
to predict operative mortality (in-hospital or 30-day) in 401684 patients
undergoing coronary or valve surgery in 1998 and 1999 as well as in 188913
patients undergoing surgery in 1995 in the Society of Thoracic Surgeons (STS)
database. RESULTS: The proportion of isolated coronary artery bypass grafting
(CABG) was greater in STS patients (84%) than in Europe (65%). STS patients
were also older (mean age 65.3 versus 62.5), and had more diabetes (30 versus
17%) and prior cardiac surgery (11 versus 7%). Other comorbidity was also
significantly more prevalent in STS patients. EuroSCORE predicted overall
mortality was virtually identical to the observed mortality (1998/1999:
predicted 3.994%, observed 3.992%; 1995: observed and predicted 4.156%).
Predicted mortality also closely matched observed mortality across the risk
groups. Discrimination was good to very good for the population overall and
for isolated CABG in both time periods, with the area under the receiver
operating characteristic curve between 0.75 and 0.78. CONCLUSION: Despite
substantial demographic differences between Europe and North America,
EuroSCORE performs very well in the STS database, and can be recommended as a
simple, additive risk stratification system on both sides of the Atlantic.