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Eur J Cardiothorac Surg 2004;25:51-58
© 2004 Elsevier Science NL
a Department of Cardiac Surgery, University Hospital of Ioannina, Ioannina, Greece
b St. Luke's Roosevelt Hospital Center at Columbia University, New York, NY, USA
Received 11 August 2003; received in revised form 18 September 2003; accepted 4 October 2003.
* Corresponding author. St. Luke's/Roosevelt Hospital Center at Columbia University, 45 East 89th Street, New York, NY 101 28, USA. Tel.: +1-212-289-8654; fax: +1-212-523-5344
e-mail: cea8{at}columbia.edu
Objective: To evaluate the accuracy of predicting long-term mortality in patients with coronary artery bypass grafting (CABG) by using the European system for cardiac operative risk evaluation (EuroSCORE). Methods: Medical records of patients with CABG (n=3760) between January 1992 and March 2002 were retrospectively reviewed and their predicted surgical risk was calculated according to the standard (study A) and logistic (study B) EuroSCORE. In study A the patients were divided into six groups: 0–2 (n=610), 3–5 (n=1479), 6–8 (n=1099), 9–11 (n=452), 12–14 (n=103) and >14 (n=17). In study B the patients were divided into seven groups: 0.00–2.00 (n=447), 2.01–5.00 (n=1190), 5.01–10.00 (n=890), 10.01–20.00 (n=686), 20.01–30.00 (n=234), 30.01–60.00 (n=254) and >60.00 (n=59). Long-term survival was obtained by the National Death Index and Kaplan–Meier curves were constructed and compared employing the log-rank test. Multivariate Cox regression analysis was performed in order to control for pre, intra and postoperative factors and adjusted hazard ratios were calculated for standard and logistic EuroSCORE groups. The receiver operating characteristic (ROC) curves were plotted to assess the discrimination ability of the EuroSCORE. Results: In study A there were differences among the six groups in 30-day mortality (0.7%, 1.0%, 3.1%, 4.6%, 13.6% and 23.5%; P<0.001), in major complications (8.5%, 10.4%, 16.2%, 20.4%, 31.1% and 35.3%; P<0.001) as well as in actuarial long-term survival (86.2%, 79.6%, 53.6%, 37.9%, 24.9% and 0% from EuroSCORE 0–2 to >14; P<0.001). In study B there were differences among the seven groups in 30-day mortality (0.9%, 1.1%, 1.2%, 3.6%, 3.4%, 8.7% and 15.3%; P<0.001), major complications (8.5%, 10.1%, 12.1%, 18.4%, 16.2%, 26.0% and 30.5%; P<0.001) as well as in actuarial long-term survival (89.5%, 79.9%, 66.9%, 51.0%, 40.3%, 38.4% and 13.7% from EuroSCORE 0.00–2.00 to >60.00; P<0.001). Multivariate Cox regression analysis confirmed that EuroSCORE (standard or logistic) was a statistically significant predictor for long-term mortality, while the area under the ROC curve was 0.72 for either standard or logistic EuroSCORE. Conclusion: The predicted surgical risk in CABG patients as calculated by standard or logistic EuroSCORE is a strong predictor for long-term survival in addition to predicting operative survival for which it was originally designed.
Key Words: Coronary artery bypass grafting • EuroSCORE • Long-term mortality
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