Performance of EuroSCORE II Compared to EuroSCORE I in Predicting Operative and Mid-term Mortality of Patients from a Single Center After Combined Coronary Artery Bypass Grafting and Aortic Valve Replacement

Overview

Journal Gen Thorac Cardiovasc Surg

Specialties Cardiology & Vascular Diseases
General Surgery
Pulmonary Medicine

Date 2013 Aug 31

PMID 23990048

Citations 7

Authors

Kyriakos Spiliopoulos

Vasilis Bagiatis

Oliver Deutsch

Bernhard M Kemkes

Nikolaos Antonopoulos

Dimos Karangelis

Ayman Haschemi

Brigitte Gansera

Affiliations

Soon will be listed here.

Abstract

Objective: The performance comparison of the recently introduced European System for Cardiac Operative Risk Evaluation II in predicting operative as well as mid-term mortality, with its previous version in patients after combined aortic valve replacement and coronary artery bypass grafting surgery.

Methods: This retrospective analysis included 216 patients operated on at one institution from 01/1999 to 12/2005. Accuracy and calibration of EuroSCORE I and II were assessed by plotting the areas under the receiver operator curves and comparing observed and predicted mortalities.

Results: EuroSCORE II showed, regarding early mortality, a slightly higher discriminatory accuracy with an area under the receiver operator curve of 0.77, while additive and logistic EuroSCORE I areas were 0.749, 0.75, respectively. The highest specificity and sensitivity level was approached for EuroSCORE II at a predicted mortality of 4.4 %. Receiver operator curves concerning mid-term mortality revealed areas for additive, logistic EuroSCORE and EuroSCORE II of 0.745, 0.739 and 0.718 with the highest accuracy levels at predicted mortalities of 6.5, 6.48 and 3.88 %, respectively. Mean predicted mortalities by logistic EuroSCORE and EuroSCORE II were 8.35 and 3.99 %, respectively, while overall observed operative mortality was 6.3 %. In "high-risk" patients (EuroSCORE > 13), EuroSCORE II underestimated early and mid-term outcomes.

Conclusions: Regarding operative mortality, EuroSCORE II showed in this study a slightly higher discriminatory accuracy than EuroSCORE I. There were no significant differences in the calibration of the two model versions in "low-" and "moderate-risk" patients regarding early as well as mid-term mortality. Analyses in larger patient populations will contribute to further model improvement.

Citing Articles

Predictive Ability of European Heart Surgery Risk Assessment System II (EuroSCORE II) and the Society of Thoracic Surgeons (STS) Score for in-Hospital and Medium-Term Mortality of Patients Undergoing Coronary Artery Bypass Grafting.

Gao F, Shan L, Wang C, Meng X, Chen J, Han L Int J Gen Med. 2021; 14:8509-8519.

PMID: 34824547 PMC: 8610380. DOI: 10.2147/IJGM.S338819.

Resistin levels in perivascular adipose tissue and mid-term mortality in patients undergoing coronary artery bypass grafting.

Rachwalik M, Obremska M, Zysko D, Matusiewicz M, Protasiewicz M, Jasinski M Physiol Res. 2021; 70(4):543-550.

PMID: 34062078 PMC: 8820548. DOI: 10.33549/physiolres.934661.

Systematic review and meta-analysis of mortality risk prediction models in adult cardiac surgery.

Sinha S, Dimagli A, Dixon L, Gaudino M, Caputo M, Vohra H Interact Cardiovasc Thorac Surg. 2021; 33(5):673-686.

PMID: 34041539 PMC: 8557799. DOI: 10.1093/icvts/ivab151.

Combination of European System for Cardiac Operative Risk Evaluation (EuroSCORE) and Cardiac Surgery Score (CASUS) to Improve Outcome Prediction in Cardiac Surgery.

Doerr F, Heldwein M, Bayer O, Sabashnikov A, Weymann A, Dohmen P Med Sci Monit Basic Res. 2015; 21:172-8.

PMID: 26279053 PMC: 4559007. DOI: 10.12659/MSMBR.895004.

Frailty in cardiothoracic surgery: systematic review of the literature.

Furukawa H, Tanemoto K Gen Thorac Cardiovasc Surg. 2015; 63(8):425-33.

PMID: 25916404 DOI: 10.1007/s11748-015-0553-8.

References

Biancari F, Kangasniemi O, Luukkonen J, Vuorisalo S, Satta J, Pokela R . EuroSCORE predicts immediate and late outcome after coronary artery bypass surgery. Ann Thorac Surg. 2006; 82(1):57-61. DOI: 10.1016/j.athoracsur.2005.11.039. View

Matsuura K, Ogino H, Matsuda H, Minatoya K, Sasaki H, Yagihara T . Limitations of EuroSCORE for measurement of risk-stratified mortality in aortic arch surgery using selective cerebral perfusion: is advanced age no longer a risk?. Ann Thorac Surg. 2006; 81(6):2084-7. DOI: 10.1016/j.athoracsur.2006.01.018. View

Barmettler H, Immer F, Berdat P, Eckstein F, Kipfer B, Carrel T . Risk-stratification in thoracic aortic surgery: should the EuroSCORE be modified?. Eur J Cardiothorac Surg. 2004; 25(5):691-4. DOI: 10.1016/j.ejcts.2004.01.003. View

Lebreton G, Merle S, Inamo J, Hennequin J, Sanchez B, Rilos Z . Limitations in the inter-observer reliability of EuroSCORE: what should change in EuroSCORE II?. Eur J Cardiothorac Surg. 2011; 40(6):1304-8. DOI: 10.1016/j.ejcts.2011.02.067. View

Akins C, Hilgenberg A, Vlahakes G, MacGillivray T, Torchiana D, Madsen J . Results of bioprosthetic versus mechanical aortic valve replacement performed with concomitant coronary artery bypass grafting. Ann Thorac Surg. 2002; 74(4):1098-106. DOI: 10.1016/s0003-4975(02)03840-7. View

Gansera B, Botzenhardt F, Gunzinger R, Spiliopoulos K, Angelis I, Kemkes B . The Mosaic bioprosthesis in the aortic position: seven years' results. J Heart Valve Dis. 2003; 12(3):354-61. View

Spiliopoulos K, Haschemi A, Parasiris P, Kemkes B . Sorin Bicarbon bileaflet valve: a 9.8-year experience. Clinical performance of the prosthesis after heart valve replacement in 587 patients. Interact Cardiovasc Thorac Surg. 2008; 8(2):252-9. DOI: 10.1510/icvts.2008.183590. View

Sergeant P, Meuris B, Pettinari M . EuroSCORE II, illum qui est gravitates magni observe. Eur J Cardiothorac Surg. 2012; 41(4):729-31. DOI: 10.1093/ejcts/ezs057. View

Karabulut H, Toraman F, Alhan C, Camur G, Evrenkaya S, Dagdelen S . EuroSCORE overestimates the cardiac operative risk. Cardiovasc Surg. 2003; 11(4):295-8. DOI: 10.1016/S0967-2109(03)00032-2. View

10.

Nashef S, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R . European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg. 1999; 16(1):9-13. DOI: 10.1016/s1010-7940(99)00134-7. View

11.

Nashef S, Roques F, Sharples L, Nilsson J, Smith C, Goldstone A . EuroSCORE II. Eur J Cardiothorac Surg. 2012; 41(4):734-44. DOI: 10.1093/ejcts/ezs043. View

12.

Di Dedda U, Pelissero G, Agnelli B, De Vincentiis C, Castelvecchio S, Ranucci M . Accuracy, calibration and clinical performance of the new EuroSCORE II risk stratification system. Eur J Cardiothorac Surg. 2012; 43(1):27-32. DOI: 10.1093/ejcts/ezs196. View

13.

Basraon J, Chandrashekhar Y, John R, Agnihotri A, Kelly R, Ward H . Comparison of risk scores to estimate perioperative mortality in aortic valve replacement surgery. Ann Thorac Surg. 2011; 92(2):535-40. DOI: 10.1016/j.athoracsur.2011.04.006. View

14.

Parolari A, Pesce L, Trezzi M, Loardi C, Kassem S, Brambillasca C . Performance of EuroSCORE in CABG and off-pump coronary artery bypass grafting: single institution experience and meta-analysis. Eur Heart J. 2009; 30(3):297-304. PMC: 2733735. DOI: 10.1093/eurheartj/ehn581. View

15.

Collart F, Feier H, Kerbaul F, Mouly-Bandini A, Riberi A, Mesana T . Valvular surgery in octogenarians: operative risks factors, evaluation of Euroscore and long term results. Eur J Cardiothorac Surg. 2005; 27(2):276-80. DOI: 10.1016/j.ejcts.2004.10.041. View

16.

Kasimir M, Bialy J, Moidl R, Simon-Kupilik N, Mittlbock M, Hiesmayr M . EuroSCORE predicts mid-term outcome after combined valve and coronary bypass surgery. J Heart Valve Dis. 2004; 13(3):439-43. View

17.

Chalmers J, Pullan M, Fabri B, McShane J, Shaw M, Mediratta N . Validation of EuroSCORE II in a modern cohort of patients undergoing cardiac surgery. Eur J Cardiothorac Surg. 2012; 43(4):688-94. DOI: 10.1093/ejcts/ezs406. View

18.

Vazquez Roque F, Fernandez Tarrio R, Pita S, Cuenca J, Herrera J, Campos V . [Preoperative risk evaluation in beating-heart coronary artery bypass surgery]. Rev Esp Cardiol. 2005; 58(11):1302-9. View

19.

Karthik S, Srinivasan A, Grayson A, Jackson M, Sharpe D, Keenan D . Limitations of additive EuroSCORE for measuring risk stratified mortality in combined coronary and valve surgery. Eur J Cardiothorac Surg. 2004; 26(2):318-22. DOI: 10.1016/j.ejcts.2004.02.007. View

20.

Biancari F, Vasques F, Mikkola R, Martin M, Lahtinen J, Heikkinen J . Validation of EuroSCORE II in patients undergoing coronary artery bypass surgery. Ann Thorac Surg. 2012; 93(6):1930-5. DOI: 10.1016/j.athoracsur.2012.02.064. View