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Eur J Cardiothorac Surg 1999;15:816-823
© 1999 Elsevier Science NL

Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients

Service de chirurgie cardiovasculaire, CHU de Fort de France, 97200Martinique, France

Received 22 September 1998; received in revised form 8 March 1999; accepted 11 March 1999.

Corresponding author. Tel.: +596-552271; fax: +596-758438; email: f.r.fwi@wanadoo.fr

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 influence 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 identifiable 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), non-coronary 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 stratification system for the prediction of hospital mortality and the assessment of quality of care.

Key Words: Risk factors • EuroSCORE database

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				F. Bakhtiary, P. Therapidis, O. Dzemali, K. Ak, H. Ackermann, D. Meininger, P. Kessler, P. Kleine, A. Moritz, T. Aybek, et al. Impact of high thoracic epidural anesthesia on incidence of perioperative atrial fibrillation in off-pump coronary bypass grafting: A prospective randomized study J. Thorac. Cardiovasc. Surg., August 1, 2007; 134(2): 460 - 464. [Abstract] [Full Text] [PDF]

				M. Gaudino, F. Girola, M. Piscitelli, L. Martinelli, A. Anselmi, C. Della Vella, R. Schiavello, and G. Possati Long-term survival and quality of life of patients with prolonged postoperative intensive care unit stay: Unmasking an apparent success J. Thorac. Cardiovasc. Surg., August 1, 2007; 134(2): 465 - 469. [Abstract] [Full Text] [PDF]

				D. Ledoux, M. Monchi, J.-P. Chapelle, and P. Damas Cystatin C blood level as a risk factor for death after heart surgery Eur. Heart J., August 1, 2007; 28(15): 1848 - 1853. [Abstract] [Full Text] [PDF]

				E. Grube, L. Buellesfeld, U. Gerckens, R. Mueller, M. Menichelli, T. Schmidt, J. C. Laborde, T. Felderhoff, S. Iversen, B. Sauren, et al. Response to Letter Regarding Article, "Percutaneous Implantation of the CoreValve Self-Expanding Valve Prosthesis in High-Risk Patients With Aortic Valve Disease: The Siegburg First-in-Man Study" Circulation, June 5, 2007; 115(22): e613 - e613. [Full Text] [PDF]

				Y.-N. Youn, Y.-L. Kwak, and K.-J. Yoo Can the EuroSCORE Predict the Early and Mid-Term Mortality After Off-Pump Coronary Artery Bypass Grafting? Ann. Thorac. Surg., June 1, 2007; 83(6): 2111 - 2117. [Abstract] [Full Text] [PDF]

				Y. Lamarche, L. P. Perrault, S. Maltais, K. Tetreault, J. Lambert, and A. Y. Denault Preliminary experience with inhaled milrinone in cardiac surgery Eur. J. Cardiothorac. Surg., June 1, 2007; 31(6): 1081 - 1087. [Abstract] [Full Text] [PDF]

				M. Mirabel, B. Iung, G. Baron, D. Messika-Zeitoun, D. Detaint, J.-L. Vanoverschelde, E. G. Butchart, P. Ravaud, and A. Vahanian What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery? Eur. Heart J., June 1, 2007; 28(11): 1358 - 1365. [Abstract] [Full Text] [PDF]

				B. Bridgewater, A. D Grayson, N. Brooks, G. Grotte, B. M Fabri, J. Au, T. Hooper, M. Jones, B. Keogh, and on behalf of the North West Quality Improvement Pr Has the publication of cardiac surgery outcome data been associated with changes in practice in northwest England: an analysis of 25 730 patients undergoing CABG surgery under 30 surgeons over eight years Heart, June 1, 2007; 93(6): 744 - 748. [Abstract] [Full Text] [PDF]

				A. S. Adabag, T. Rector, S. Mithani, J. Harmala, H. B. Ward, R. F. Kelly, J. T. Nguyen, E. O. McFalls, and H. E. Bloomfield Prognostic Significance of Elevated Cardiac Troponin I After Heart Surgery Ann. Thorac. Surg., May 1, 2007; 83(5): 1744 - 1750. [Abstract] [Full Text] [PDF]

				M. Paul, A. Raz, L. Leibovici, H. Madar, R. Holinger, and B. Rubinovitch Sternal wound infection after coronary artery bypass graft surgery: Validation of existing risk scores J. Thorac. Cardiovasc. Surg., February 1, 2007; 133(2): 397 - 403. [Abstract] [Full Text] [PDF]

				M. Valgimigli, K. Dawkins, C. Macaya, B. de Bruyne, E. Teiger, J. Fajadet, R. Gert, S. De Servi, A. Ramondo, K. Wittebols, et al. Impact of Stable Versus Unstable Coronary Artery Disease on 1-Year Outcome in Elective Patients Undergoing Multivessel Revascularization With Sirolimus-Eluting Stents: A Subanalysis of the ARTS II Trial J. Am. Coll. Cardiol., January 30, 2007; 49(4): 431 - 441. [Abstract] [Full Text] [PDF]

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