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

European system for cardiac operative risk evaluation (EuroSCORE)

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. 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]

				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]

				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]

				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]

				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]

				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]

				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]

				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]

				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]

				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]

				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]

				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]

				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]

				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]

				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]

				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]

				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]

				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]

				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]

				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]