Abstract
Objective
The EuroSCORE risk stratification model has been developed in 1995 and is still widely used to assess individual patient risk prior to cardiac surgery. Furthermore, the score advanced to a decision tool to determine so-called “high-risk patients” and in consequence serves as an important selection criterion in new technologies, such as the catheter-based aortic valve replacement. Several studies with relatively small patient numbers showed a substantial overestimation of risk by the EuroSCORE. The aim of our study was to evaluate whether the nationwide data support this finding.
Methods
A subgroup of the registry of the German Society of Thoracic and Cardiovascular Surgery from 2006 and 2007, with 32,806 patients undergoing isolated coronary surgery and isolated aortic valve replacement was investigated.
Results
The overall hospital mortality in isolated coronary surgery in this patient cohort (n = 26,501 patients) was 2.6% (n = 695). The overall hospital mortality in isolated aortic valve replacement in this patient cohort (n = 6,305 patients) was 3.9% (n = 245). The logistic EuroSCORE predicted a proportion of 5.2% for patients with isolated CABG and 7.3% for patients with isolated aortic valve replacement. The area under the receiver operating characteristic curve was 0.77 for isolated CABG procedures and 0.69 for isolated valve procedures, supporting the substantial lack of predictive value of the EuroSCORE.
Conclusion
The logistic EuroSCORE insufficiently evaluates the risk of the current patient population and therefore should be carefully used as a tool for important therapeutic decision-making.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Alexiou K, Kappert U, Staroske A, Joskowiak D, Wilbring M, Matschke K et al (2008) Coronary surgery for acute coronary syndrome: which determinants of outcome remain? Clin Res Cardiol 97(9):601–608
Bhatti F, Grayson AD, Grotte G, Fabri BM, Au J, Jones M et al (2006) The logistic EuroSCORE in cardiac surgery: how well does it predict operative risk? Heart 92(12):1817–1820
Blackstone EH (2006) Thinking beyond the risk factors. Eur J Cardiothorac Surg 29(5):645–652
Bruch C, Bruch C, Sindermann J, Breithardt G, Gradaus R (2007) Prevalence and prognostic impact of comorbidities in heart failure patients with implantable cardioverter defibrillator. Europace 9(8):681–686
Collart F, Feier H, Kerbaul F, Mouly-Bandini A, Riberi A, Mesana TG et al (2005) Valvular surgery in octogenarians: operative risks factors, evaluation of Euroscore and long term results. Eur J Cardiothorac Surg 27(2):276–280
Grossi EA, Schwartz CF, Yu PJ, Jorde UP, Crooke GA, Grau JB et al (2008) High-risk aortic valve replacement: are the outcomes as bad as predicted? Ann Thorac Surg 85(1):102–106
Grube E, Schuler G, Buellesfeld L, Gerckens U, Linke A, Wenaweser P et al (2007) Percutaneous aortic valve replacement for severe aortic stenosis in high-risk patients using the second- and current third-generation self-expanding CoreValve prosthesis: device success and 30-day clinical outcome. J Am Coll Cardiol 50(1):69–76
Gummert JF, Funkat A, Beckmann A, Hekmat K, Ernst M, Krian A (2006) Cardiac surgery in Germany during 2005: a report on behalf of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg 54(5):362–371
Gummert JF, Funkat A, Beckmann A, Schiller W, Hekmat K, Ernst M et al (2007) Cardiac surgery in Germany during 2006: a report on behalf of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg 55(6):343–350
Gummert JF, Funkat A, Krian A (2005) Cardiac surgery in Germany during 2004: a report on behalf of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg 53(6):391–399
Herbert MA, Prince SL, Williams JL, Magee MJ, Mack MJ (2004) Are unaudited records from an outcomes registry database accurate? Ann Thorac Surg 77(6):1960–1964
Mesana T (2008) High-risk cardiac surgery: clinical judgment prevails on risk stratification. Curr Opin Cardiol 23(2):97–98
Nashef SA, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R (1999) European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 16(1):9–13
Parsonnet V, Dean D, Bernstein AD (1989) A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease. Circulation 79(6 Pt 2):I3–12
Roques F, Michel P, Goldstone AR, Nashef SA (2003) The logistic EuroSCORE. Eur Heart J 24(9):881–882
Roques F, Nashef SA, Michel P, Gauducheau E, de Vincentiis C, Baudet E et al (1999) Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg 15(6):816–822
Sack S, Kahlert P, Khandanpour S, Naber C, Philipp S, Mohlenkamp S et al (2008) Revival of an old method with new techniques: balloon aortic valvuloplasty of the calcified aortic stenosis in the elderly. Clin Res Cardiol 97(5):288–297
Zingone B, Pappalardo A, Dreas L (2004) Logistic versus additive EuroSCORE. A comparative assessment of the two models in an independent population sample. Eur J Cardiothorac Surg 26(6):1134–1140
Acknowledgments
On behalf of the German Society for Thoracic and Cardiovascular Surgery, the authors would like to thank the chairmen and their co-workers of all cardiac surgery units in Germany for their continuous cooperation and support for realizing the German registry.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gummert, J.F., Funkat, A., Osswald, B. et al. EuroSCORE overestimates the risk of cardiac surgery: results from the national registry of the German Society of Thoracic and Cardiovascular Surgery. Clin Res Cardiol 98, 363–369 (2009). https://doi.org/10.1007/s00392-009-0010-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00392-009-0010-8