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Eur J Cardiothorac Surg 2003;23:684-687
© 2003 Elsevier Science NL
a University of Bordeaux, Bordeaux, France
b CHU Fort de France, Martinique, France
c Papworth Hospital, Cambridge CB3 8RE, UK
Received 21 September 2002; received in revised form 21 January 2003; accepted 23 January 2003.
* Corresponding author. Tel.: +44-1480-364299; fax: +44-1480-364744
e-mail: sam.nashef{at}euroscore.org
Objectives: To assess whether the use of the full logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) is superior to the standard additive EuroSCORE in predicting mortality in high-risk cardiac surgical patients. Methods: Both the simple additive EuroSCORE and the full logistic EuroSCORE were applied to 14,799 cardiac surgical patients from across Europe, of whom there were 4293 high-risk patients (additive EuroSCORE of 6 or more). The systems were compared for absolute prediction and discrimination (area under the receiver operating characteristic (ROC) curve). Results: Actual mortality was 4.72%. The logistic model was closer to this than the additive model (4.84% (4.72–4.94) versus 4.21 (4.21–4.26)). Most of this difference was due to high-risk patients where actual mortality was 11.18% and predicted was 7.83% (additive) and 11.23% (logistic). Discrimination was similar in both systems as measured by the area under the ROC curve (additive 0.783, logistic 0.785). Conclusions: The additive EuroSCORE model remains a simple "gold standard" for risk assessment in European cardiac surgery, usable at the bedside without complex calculations or information technology. The logistic model is a better risk predictor especially in high-risk patients and may be of interest to institutions engaged in the study and development of risk stratification.
Key Words: EuroSCORE • Risk stratification • Cardiac surgery
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