HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sergeant, P. Articles by Meyns, B. Search for Related Content PubMed PubMed Citation Articles by Sergeant, P. Articles by Meyns, B. Related Collections Coronary disease

Eur J Cardiothorac Surg 2001;20:1176-1182
© 2001 Elsevier Science NL

Single centre, single domain validation of the EuroSCORE on a consecutive sample of primary and repeat CABG

Cardiac Surgery Department, Gasthuisberg University Hospital, 3000 Leuven, Belgium

Received 25 September 2000; received in revised form 11 June 2001; accepted 24 September 2001.

Corresponding author. Tel.: +32-16-344339; fax: +32-16-344616
e-mail: paul.sergeant{at}uz.kuleuven.ac.be

Objectives: Intra- and interdepartmental benchmarking require scoring systems with excellent performance on several properties: discrimination (resolution), reliability (calibration) and stability over the complete spectrum of peri-procedural risk. This single centre, single domain study validates the European system for cardiac operative risk evaluation (EuroSCORE) on an independent sample of primary and repeat coronary artery bypass grafting (CABG) patients and will evaluate these different properties. Methods: The study population is a consecutive series of 2051 isolated primary and repeat CABG patients, inclusive of patients in cardiogenic shock or resuscitation, operated on in a single institution from January 1997 to July 2000. The age of the patients was 66±9 years, 77% were males and 7% were repeat procedures. The EuroSCORE was 5.0±3%, with a range from 0 to 22. The studied event was in-hospital death, defined as mortality during hospital stay, which was unlimited in time and included a stay in a secondary hospital without discharge home. Results: The EuroSCORE predicted 102 deaths versus 81 deaths observed (P=0.14, Fisher exact test). The EuroSCORE described only 20% of the variance of in-hospital mortality. The EuroSCORE created an area under the receiver operating characteristic curve of 0.83±0.03. The highest discriminative accuracy was obtained with 8% EuroSCORE risk (only 64% sensitivity and 87% specificity). Further exploration identified an over score in the EuroSCORE range 0–8 (57%, P<0.0001). There was an equal score (-2%, P=1) in the range 9–11, but an under score in the range 12–22 (-133%, P=0.003). Conclusions: On the condition that these single centre results could be extended to any European cardiac surgery centre, it can be concluded that the overall acceptable performance of the EuroSCORE is the result of an over score in the lower risk and insufficient correction in the higher risk spectrum. The EuroSCORE is probably refined enough for improved informed consent versus aggregated results but should only be used for inter-institutional benchmarking with great caution, preferably below the 12% risk pivot.

Key Words: Coronary artery bypass grafting • EuroSCORE • Scoring system • Validation • Quality control

This article has been cited by other articles:

				M. L. Brown, H. V. Schaff, M. E. Sarano, Z. Li, T. M. Sundt, J. A. Dearani, C. J. Mullany, and T. A. Orszulak Is the European System for Cardiac Operative Risk Evaluation model valid for estimating the operative risk of patients considered for percutaneous aortic valve replacement? J. Thorac. Cardiovasc. Surg., September 1, 2008; 136(3): 566 - 571. [Abstract] [Full Text] [PDF]

				A. A. Klein and S. A. M. Nashef Perception and Reporting of Cardiac Surgical Performance Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2008; 12(3): 184 - 190. [Abstract] [PDF]

				E. A. Grossi, C. F. Schwartz, P.-J. Yu, U. P. Jorde, G. A. Crooke, J. B. Grau, G. H. Ribakove, F. G. Baumann, P. Ursumanno, A. T. Culliford, et al. High-Risk Aortic Valve Replacement: Are the Outcomes as Bad as Predicted? Ann. Thorac. Surg., January 1, 2008; 85(1): 102 - 107. [Abstract] [Full Text] [PDF]

				G. Shanmugam, M. West, and G. Berg Additive and logistic EuroSCORE performance in high risk patients Interactive CardioVascular and Thoracic Surgery, August 1, 2005; 4(4): 299 - 303. [Abstract] [Full Text] [PDF]

				T. Caus, Y. Seree, P. Marin, M. Khairi, A. Bakkali, J. C. Guillen, J. L. Bonnet, and D. Metras Off-pump coronary surgery in selected patients: better early outcome but more recurrence of angina? Interactive CardioVascular and Thoracic Surgery, August 1, 2005; 4(4): 322 - 326. [Abstract] [Full Text] [PDF]

				C.-C. Chen, C.-C. Wang, S.-R. Hsieh, H.-W. Tsai, H.-J. Wei, and Y. Chang Application of European system for cardiac operative risk evaluation (EuroSCORE) in coronary artery bypass surgery for Taiwanese Interactive CardioVascular and Thoracic Surgery, December 1, 2004; 3(4): 562 - 565. [Abstract] [Full Text] [PDF]

				B. Zingone, A. Pappalardo, and L. Dreas Logistic versus additive EuroSCORE. A comparative assessment of the two models in an independent population sample Eur. J. Cardiothorac. Surg., December 1, 2004; 26(6): 1134 - 1140. [Abstract] [Full Text] [PDF]

				A. Gogbashian, A. Sedrakyan, and T. Treasure EuroSCORE: a systematic review of international performance Eur. J. Cardiothorac. Surg., May 1, 2004; 25(5): 695 - 700. [Abstract] [Full Text] [PDF]

				A.A. Albert, J.A. Walter, B. Arnrich, W. Hassanein, U.P. Rosendahl, S. Bauer, and J. Ennker On-line variable live-adjusted displays with internal and external risk-adjusted mortalities. A valuable method for benchmarking and early detection of unfavourable trends in cardiac surgery Eur. J. Cardiothorac. Surg., March 1, 2004; 25(3): 312 - 319. [Abstract] [Full Text] [PDF]

				I. K. Toumpoulis, C. E. Anagnostopoulos, J. J. DeRose, and D. G. Swistel European system for cardiac operative risk evaluation predicts long-term survival in patients with coronary artery bypass grafting Eur. J. Cardiothorac. Surg., January 1, 2004; 25(1): 51 - 58. [Abstract] [Full Text] [PDF]

				R. V.H.P. Huijskes, P. M.J. Rosseel, and J. G.P. Tijssen Outcome prediction in coronary artery bypass grafting and valve surgery in the Netherlands: development of the Amphiascore and its comparison with the Euroscore Eur. J. Cardiothorac. Surg., November 1, 2003; 24(5): 741 - 749. [Abstract] [Full Text] [PDF]

				P. Sergeant, B. Meyns, P. Wouters, R. Demeyere, and P. Lauwers Long-term outcome after coronary artery bypass grafting in cardiogenic shock or cardiopulmonary resuscitation J. Thorac. Cardiovasc. Surg., November 1, 2003; 126(5): 1279 - 1286. [Abstract] [Full Text] [PDF]

				G. L. Grunkemeier, Y. X. Wu, and A. P. Furnary Cumulative sum techniques for assessing surgical results Ann. Thorac. Surg., September 1, 2003; 76(3): 663 - 667. [Full Text] [PDF]

				P. Michel, F. Roques, S. A.M. Nashef, and The EuroSCORE Project Group Logistic or additive EuroSCORE for high-risk patients? Eur. J. Cardiothorac. Surg., May 1, 2003; 23(5): 684 - 687. [Abstract] [Full Text] [PDF]

				A. M. Calafiore, M. Di Mauro, C. Canosa, G. Di Giammarco, A. L. Iaco, and M. Contini Early and late outcome of myocardial revascularization with and without cardiopulmonary bypass in high risk patients (EuroSCORE>=6) Eur. J. Cardiothorac. Surg., March 1, 2003; 23(3): 360 - 367. [Abstract] [Full Text] [PDF]