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Eur J Cardiothorac Surg 1999;16:9-13
© 1999 Elsevier Science NL

European system for cardiac operative risk evaluation (EuroSCORE)

S.A.M. Nashef, F. Roques, P. Michel, E. Gauducheau, S. Lemeshow, R. Salamon, the EuroSCORE study group

Papworth Hospital, Cambridge CB3 8RE, UK

Corresponding author. Tel.: +44-1480-830541; EuroSCORE website: euroscore.co.uk
e-mail: sam.nashef{at}papworth-tr.anglox.nhs.uk

Objective: To construct a scoring system for the prediction of early mortality in cardiac surgical patients in Europe on the basis of objective risk factors. Methods: The EuroSCORE database was divided into developmental and validation subsets. In the former, risk factors deemed to be objective, credible, obtainable and difficult to falsify were weighted on the basis of regression analysis. An additive score of predicted mortality was constructed. Its calibration and discrimination characteristics were assessed in the validation dataset. Thresholds were defined to distinguish low, moderate and high risk groups. Results: The developmental dataset had 13 302 patients, calibration by Hosmer Lemeshow Chi square was (8)=8.26 (P<0.40) and discrimination by area under ROC curve was 0.79. The validation dataset had 1479 patients, calibration Chi square (10)=7.5, P<0.68 and the area under the ROC curve was 0.76. The scoring system identified three groups of risk factors with their weights (additive % predicted mortality) in brackets. Patient-related factors were age over 60 (one per 5 years or part thereof), female (1), chronic pulmonary disease (1), extracardiac arteriopathy (2), neurological dysfunction (2), previous cardiac surgery (3), serum creatinine >200 µmol/l (2), active endocarditis (3) and critical preoperative state (3). Cardiac factors were unstable angina on intravenous nitrates (2), reduced left ventricular ejection fraction (30–50%: 1, <30%: 3), recent (<90 days) myocardial infarction (2) and pulmonary systolic pressure >60 mmHg (2). Operation-related factors were emergency (2), other than isolated coronary surgery (2), thoracic aorta surgery (3) and surgery for postinfarct septal rupture (4). The scoring system was then applied to three risk groups. The low risk group (EuroSCORE 1-2) had 4529 patients with 36 deaths (0.8%), 95% confidence limits for observed mortality (0.56–1.10) and for expected mortality (1.27–1.29). The medium risk group (EuroSCORE 3–5) had 5977 patients with 182 deaths (3%), observed mortality (2.62–3.51), predicted (2.90–2.94). The high risk group (EuroSCORE 6 plus) had 4293 patients with 480 deaths (11.2%) observed mortality (10.25–12.16), predicted (10.93–11.54). Overall, there were 698 deaths in 14 799 patients (4.7%), observed mortality (4.37–5.06), predicted (4.72–4.95). Conclusion: EuroSCORE is a simple, objective and up-to-date system for assessing heart surgery, soundly based on one of the largest, most complete and accurate databases in European cardiac surgical history. We recommend its widespread use.

Key Words: Cardiac surgery • Risk stratification • Mortality




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F. Biancari, O.-P. Kangasniemi, M. AliAsim Mahar, E. Rasinaho, A. Satomaa, V. Tiozzo, M. Niemela, and M. Lepojarvi
Changing risk of patients undergoing coronary artery bypass surgery
Interactive CardioVascular and Thoracic Surgery, January 1, 2009; 8(1): 40 - 44.
[Abstract] [Full Text] [PDF]


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HeartHome page
M. A de Belder and L. Hamilton
Evaluating risks and benefits in coronary revascularisation--a very imperfect art?
Heart, January 1, 2009; 95(1): 6 - 8.
[Full Text] [PDF]


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HeartHome page
E Romagnoli, F Burzotta, C Trani, M Siviglia, G G L Biondi-Zoccai, G Niccoli, A M Leone, I Porto, M A Mazzari, R Mongiardo, et al.
EuroSCORE as predictor of in-hospital mortality after percutaneous coronary intervention
Heart, January 1, 2009; 95(1): 43 - 48.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
N. Motomura, H. Miyata, H. Tsukihara, M. Okada, S. Takamoto, and Japan Cardiovascular Surgery Database Organization
First Report on 30-day and Operative Mortality in Risk Model of Isolated Coronary Artery Bypass Grafting in Japan
Ann. Thorac. Surg., December 1, 2008; 86(6): 1866 - 1872.
[Abstract] [Full Text] [PDF]


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Circ Cardiovasc IntervHome page
T. Palmerini, A. Marzocchi, C. Tamburino, I. Sheiban, M. Margheri, G. Vecchi, G. Sangiorgi, A. Santarelli, A. Bartorelli, C. Briguori, et al.
Impact of Bifurcation Technique on 2-Year Clinical Outcomes in 773 Patients With Distal Unprotected Left Main Coronary Artery Stenosis Treated With Drug-Eluting Stents
Circ Cardiovasc Interv, December 1, 2008; 1(3): 185 - 192.
[Abstract] [Full Text] [PDF]


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ICVTSHome page
J. Silva, N. Ridao-Cano, A. Segura, L. C. Maroto, J. Cobiella, M. Carnero, A. Barrientos, and J. E. Rodriguez
Can estimated glomerular filtration rate improve the EuroSCORE?
Interactive CardioVascular and Thoracic Surgery, December 1, 2008; 7(6): 1054 - 1057.
[Abstract] [Full Text] [PDF]


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HeartHome page
J Mascherbauer, R Rosenhek, C Fuchs, E Pernicka, U Klaar, C Scholten, M Heger, G Wollenek, G Maurer, and H Baumgartner
Moderate patient-prosthesis mismatch after valve replacement for severe aortic stenosis has no impact on short-term and long-term mortality
Heart, December 1, 2008; 94(12): 1639 - 1645.
[Abstract] [Full Text] [PDF]


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Eur. J. Cardiothorac. Surg.Home page
F. Filsoufi, P. B. Rahmanian, J. G. Castillo, J. Chikwe, and D. H. Adams
Logistic risk model predicting postoperative respiratory failure in patients undergoing valve surgery
Eur. J. Cardiothorac. Surg., November 1, 2008; 34(5): 953 - 959.
[Abstract] [Full Text] [PDF]


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PerfusionHome page
R Rimpilainen, F Biancari, J. Wistbacka, P Loponen, S. Koivisto, J Rimpilainen, K Teittinen, and J Nissinen
Outcome after coronary artery bypass surgery with miniaturized versus conventional cardiopulmonary bypass
Perfusion, November 1, 2008; 23(6): 361 - 367.
[Abstract] [PDF]


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Ann. Thorac. Surg.Home page
D. L. Ngaage, S. Griffin, L. Guvendik, M. E. Cowen, and A. R.J. Cale
Changing Operative Characteristics of Patients Undergoing Operations for Coronary Artery Disease: Impact on Early Outcomes
Ann. Thorac. Surg., November 1, 2008; 86(5): 1424 - 1430.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
R. Gottardi, M. Funovics, N. Eggers, A. Hirner, M. Dorfmeister, J. Holfeld, D. Zimpfer, M. Schoder, K. Donas, E. Weigang, et al.
Supra-aortic Transposition for Combined Vascular and Endovascular Repair of Aortic Arch Pathology
Ann. Thorac. Surg., November 1, 2008; 86(5): 1524 - 1529.
[Abstract] [Full Text] [PDF]


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Eur. J. Cardiothorac. Surg.Home page
A. L.P. Markou, A. van der Windt, H. A. van Swieten, and L. Noyez
Changes in quality of life, physical activity, and symptomatic status one year after myocardial revascularization for stable angina
Eur. J. Cardiothorac. Surg., November 1, 2008; 34(5): 1009 - 1015.
[Abstract] [Full Text] [PDF]


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Eur. J. Cardiothorac. Surg.Home page
B. O. Jensen, L. S. Rasmussen, and D. A. Steinbruchel
Cognitive outcomes in elderly high-risk patients 1 year after off-pump versus on-pump coronary artery bypass grafting. A randomized trial
Eur. J. Cardiothorac. Surg., November 1, 2008; 34(5): 1016 - 1021.
[Abstract] [Full Text] [PDF]


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Nephrol Dial TransplantHome page
F. Filsoufi, J. Chikwe, J. G. Castillo, P. B. Rahmanian, J. Vassalotti, and D. H. Adams
Prosthesis type has minimal impact on survival after valve surgery in patients with moderate to end-stage renal failure
Nephrol. Dial. Transplant., November 1, 2008; 23(11): 3613 - 3621.
[Abstract] [Full Text] [PDF]


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ChestHome page
E. Bouza, M. J. Perez, P. Munoz, C. Rincon, J. M. Barrio, and J. Hortal
Continuous Aspiration of Subglottic Secretions in the Prevention of Ventilator-Associated Pneumonia in the Postoperative Period of Major Heart Surgery
Chest, November 1, 2008; 134(5): 938 - 946.
[Abstract] [Full Text] [PDF]


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HeartHome page
P. F Ludman
Assessing the risks of percutaneous coronary intervention: do we have an equivalent of the EuroSCORE?
Heart, November 1, 2008; 94(11): 1366 - 1369.
[Full Text] [PDF]


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CirculationHome page
2006 WRITING COMMITTEE MEMBERS, R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, et al.
2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
Circulation, October 7, 2008; 118(15): e523 - e661.
[Full Text] [PDF]


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J Am Coll Cardiol IntvHome page
V. C. Babaliaros, D. Liff, E. P. Chen, J. H. Rogers, R. A. Brown, V. H. Thourani, R. A. Guyton, S. Lerakis, A. E. Stillman, P. Raggi, et al.
Can Balloon Aortic Valvuloplasty Help Determine Appropriate Transcatheter Aortic Valve Size?
J. Am. Coll. Cardiol. Intv., October 1, 2008; 1(5): 580 - 586.
[Abstract] [Full Text] [PDF]


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Circ Cardiovasc IntervHome page
J. Schofer, M. Schluter, H. Treede, O. W. Franzen, T. Tubler, A. Pascotto, R. I. Low, S. F. Bolling, T. Meinertz, and H. Reichenspurner
Retrograde Transarterial Implantation of a Nonmetallic Aortic Valve Prosthesis in High-Surgical-Risk Patients With Severe Aortic Stenosis: A First-in-Man Feasibility and Safety Study
Circ Cardiovasc Interv, October 1, 2008; 1(2): 126 - 133.
[Abstract] [Full Text] [PDF]


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CirculationHome page
N. Motomura, H. Miyata, H. Tsukihara, S. Takamoto, and from the Japan Cardiovascular Surgery Database Org
Risk Model of Thoracic Aortic Surgery in 4707 Cases From a Nationwide Single-Race Population Through a Web-Based Data Entry System: The First Report of 30-Day and 30-Day Operative Outcome Risk Models for Thoracic Aortic Surgery
Circulation, September 30, 2008; 118(14_suppl_1): S153 - S159.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al.
2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
J. Am. Coll. Cardiol., September 23, 2008; 52(13): e1 - e142.
[Full Text] [PDF]


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SEMIN CARDIOTHORAC VASC ANESTHHome page
J. Granton and D. Cheng
Risk Stratification Models for Cardiac Surgery
Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2008; 12(3): 167 - 174.
[Abstract] [PDF]


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Eur Heart JHome page
A. Chieffo, S.-J. Park, E. Meliga, I. Sheiban, M. S. Lee, A. Latib, Y.-H. Kim, M. Valgimigli, D. Sillano, V. Magni, et al.
Late and very late stent thrombosis following drug-eluting stent implantation in unprotected left main coronary artery: a multicentre registry
Eur. Heart J., September 1, 2008; 29(17): 2108 - 2115.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
H. Hamdalla and D. J. Moliterno
Late drug-eluting stent thrombosis in unprotected left main coronary artery lesions--sometimes possible, but rarely definite or probable
Eur. Heart J., September 1, 2008; 29(17): 2064 - 2066.
[Full Text] [PDF]


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Br J AnaesthHome page
R. G. Craig and J. M. Hunter
Recent developments in the perioperative management of adult patients with chronic kidney disease
Br. J. Anaesth., September 1, 2008; 101(3): 296 - 310.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
C.-H. Yap, L. Lau, M. Krishnaswamy, M. Gaskell, and M. Yii
Age of Transfused Red Cells and Early Outcomes After Cardiac Surgery
Ann. Thorac. Surg., August 1, 2008; 86(2): 554 - 559.
[Abstract] [Full Text] [PDF]


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Eur. J. Cardiothorac. Surg.Home page
N. J. Howell, B. E. Keogh, R. S. Bonser, T. R. Graham, J. Mascaro, S. J. Rooney, I. C. Wilson, and D. Pagano
Mild renal dysfunction predicts in-hospital mortality and post-discharge survival following cardiac surgery.
Eur. J. Cardiothorac. Surg., August 1, 2008; 34(2): 390 - 395.
[Abstract] [Full Text] [PDF]


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J. Thorac. Cardiovasc. Surg.Home page
A. A. Fox, S. K. Shernan, C. D. Collard, K.-Y. Liu, S. F. Aranki, S. M. DeSantis, P. Jarolim, and S. C. Body
Preoperative B-type natriuretic peptide is as independent predictor of ventricular dysfunction and mortality after primary coronary artery bypass grafting.
J. Thorac. Cardiovasc. Surg., August 1, 2008; 136(2): 452 - 461.
[Abstract] [Full Text] [PDF]


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ICVTSHome page
P. Loponen, M. Luther, J. Nissinen, J.-O. Wistbacka, F. Biancari, J. Laurikka, H. Sintonen, and M. R. Tarkka
EuroSCORE predicts health-related quality of life after coronary artery bypass grafting
Interactive CardioVascular and Thoracic Surgery, August 1, 2008; 7(4): 564 - 568.
[Abstract] [Full Text] [PDF]


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J Am Coll Cardiol IntvHome page
P. T.L. Chiam and C. E. Ruiz
Percutaneous Transcatheter Aortic Valve Implantation: Assessing Results, Judging Outcomes, and Planning Trials: The Interventionalist Perspective
J. Am. Coll. Cardiol. Intv., August 1, 2008; 1(4): 341 - 350.
[Abstract] [Full Text] [PDF]


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NEJMHome page
M. Pocar, F. Donatelli, A. Moneta, H. Tomoda, J. A. Tayek, J. R. Arnold, A. P. Banning, S.-J. Park, D.-W. Park, and Y.-H. Kim
Stents versus Bypass Grafting for Left Main Coronary Artery Disease
N. Engl. J. Med., July 24, 2008; 359(4): 423 - 425.
[Full Text] [PDF]


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Ann. Thorac. Surg.Home page
S. Roedler, M. Czerny, J. Neuhauser, D. Zimpfer, R. Gottardi, D. Dunkler, E. Wolner, and M. Grimm
Mechanical Aortic Valve Prostheses in the Small Aortic Root: Top Hat Versus Standard CarboMedics Aortic Valve
Ann. Thorac. Surg., July 1, 2008; 86(1): 64 - 70.
[Abstract] [Full Text] [PDF]


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Eur. J. Cardiothorac. Surg.Home page
H. Grubitzsch, C. Grabow, H. Orawa, and W. Konertz
Factors predicting the time until atrial fibrillation recurrence after concomitant left atrial ablation.
Eur. J. Cardiothorac. Surg., July 1, 2008; 34(1): 67 - 72.
[Abstract] [Full Text] [PDF]




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