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Editorial comment

The EuroSCORE risk stratification system in the current era: how accurate is it and what should be done if it is inaccurate?

^a Department of Cardiothoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge CB23 3RE, UK
^b Department of Surgery, The University of Cambridge, Cambridge, UK
^c Cardiac Surgery Department, Leuven University Hospital Gasthuisberg, Leuven B-3000, Belgium
^d Department of Cardiothoracic Surgery, Monash Medical Centre, Southern Health, Monash University, Melbourne, Victoria, Australia
^e University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK
^f National Institute for Clinical Outcomes Research, University College of London, UK

^_* Corresponding author. Address: Papworth Hospital, The University of Cambridge, Cambridge CB23 3RE, UK. Tel.: +44 1480 364573. (Email: cliffchoong@hotmail.com).

Key Words: Logistic EuroSCORE • Risk stratification model • Cardiac • Coronary artery bypass surgery • Recalibration

The first 300 words of the full text of this article appear below.

The study by Zheng et al. on ‘The Chinese Coronary Artery Bypass Grafting Registry Study: how well does the EuroSCORE predict operative risk for Chinese population?’ has found an overestimation of the predicted in-hospital mortality using the logistic EuroSCORE risk stratification model [1]. In their study, Zheng et al. have evaluated 9248 cardiac surgical patients who underwent surgery between January 2004 and December 2005. The predicted mortality was 5.51% while the observed mortality was 3.27%. In the subgroup of 8120 patients who had isolated coronary artery bypass grafting (CABG) surgery, the predicted mortality by logistic EuroSCORE model was 4.21% while the observed mortality was 2.22%. Discrimination was tested by determining the area under the receiver operating characteristic (ROC) and this was 0.72 for the entire cohort and 0.71 for the isolated CABG subset. In view of these findings, the authors concluded that the logistic EuroSCORE model over-predicts in-hospital mortality and therefore does not accurately predict outcomes in this group of Chinese CABG patients [1].

This article is timely and highlights a number of important points:

1. The logistic EuroSCORE risk stratification system was developed and validated within the European population [2,3]. There should be caution in the utilisation of any particular risk stratification system outside the countries of origins, and it is important to carefully evaluate the validity of such system amongst foreign population [4–6].

2. The additive EuroSCORE risk model was developed utilising data from 14781 patients from 128 surgical centres in 8 European states who underwent surgery between September and November 1995, and was published in 1999 [7,8]. Subsequently the logistic EuroSCORE model was developed to provide a better risk predictor, especially in high-risk patients and was published in 2003 [2,3]. The model is now 6 years old and was developed based . . . [Full Text of this Article]

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