Limitations of additive EuroSCORE for measuring risk stratified mortality in combined coronary and valve surgery.
OBJECTIVE
To study the use of the additive and logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) to predict mortality following adult combined coronary artery bypass grafting (CABG) and valve surgery.


METHODS
Data were collected prospectively, from all four centres providing adult cardiac surgery in the north west of England, on 1769 consecutive patients undergoing combined CABG and valve surgery between April 1997 and March 2002. Observed in-hospital mortality was compared to predicted mortality as determined by both additive and logistic EuroSCORE.


RESULTS
Observed mortality for simultaneous CABG and valve surgery was 8.7%, compared to 6.7% (additive) and 9.4% (logistic). Sixty-five percent of patients were classified as high-risk (additive EuroSCORE >5); the observed mortality was 11.5%, compared to 8.1% (additive) and 12.8% (logistic). Discrimination was similar in both systems as measured by the C statistic (additive 0.73, logistic 0.73).


CONCLUSIONS
The logistic EuroSCORE is more accurate at predicting mortality in simultaneous CABG and valve surgery, as the additive EuroSCORE significantly under-predicts in this high-risk group.
Karthik
Shishir
S
Department of Cardiothoracic Surgery and Clinical Governance, The Cardiothoracic Centre-Liverpool, Thomas Drive, Liverpool L14 3PE, UK.
Srinivasan
Arun K
AK
Grayson
Antony D
AD
Jackson
Mark
M
Sharpe
David A C
DA
Keenan
Daniel J M
DJ
Bridgewater
Ben
B
Fabri
Brian M
BM
D000328:Adult; D006348:Cardiac Surgical Procedures / Q000401:mortality; D001026:Coronary Artery Bypass / Q000401:mortality*; D006351:Heart Valves / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate