title: EuroSCORE predicts short- and mid-term mortality in combined aortic valve replacement and coronary artery bypass patients.
abstract: OBJECTIVE
  European system for cardiac operative risk evaluation (EuroSCORE) has been studied for its effectiveness in predicting operative mortality, and more recently, long-term mortality in a wide variety of cardiac surgical procedures. Combined coronary artery bypass and aortic valve replacement (AVR-CABG) carries increased perioperative risk, and tends to have higher-risk patients. Performance of the EuroSCORE system in patients undergoing concomitant AVR-CABG has not been well established. Thus, we aimed to analyze the accuracy of both additive and logistic EuroSCOREs in predicting operative and mid-term mortality.
  
  
  METHODS
  We retrospectively reviewed and calculated EuroSCOREs for all patients who underwent AVR-CABG between January 2000 and December 2004. Patients who had previous cardiac surgery and those undergoing any concomitant procedures were excluded. Areas under the receiver operator curves (ROC) were determined to assess EuroSCORE's accuracy in predicting operative mortality. Kaplan-Meier analysis and Cox regression were used to determine mid-term survival, freedom from repeat revascularization, and predictors of these outcomes.
  
  
  RESULTS
  There were 233 patients who met study criteria. Mean follow-up period was 2.2 +/- 1.7 years with one patient lost to follow-up. Mean additive and logistic EuroSCOREs were 8.77 and 16.1, respectively, with an observed mortality of 9.44%. The area under the ROC curves for additive EuroSCORE was 0.76 and for logistic EuroSCORE was 0.75. Regression analysis revealed additive EuroSCORE, but not logistic EuroSCORE, to be predictive of mid-term mortality.
  
  
  CONCLUSIONS
  Both additive and logistic EuroSCOREs were accurate in predicting operative morality. Only additive EuroSCORE was predictive of mid-term mortality in AVR-CABG patients. EuroSCORE remains a good and well-validated risk stratification model applicable to patients who undergo concomitant AVR-CABG.
authors.affiliation: Division of Cardiac Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Kimiyoshi J
authors.initials: KJ
authors.lastname: Kobayashi
authors.forename: Jason A
authors.initials: JA
authors.lastname: Williams
authors.forename: Lois U
authors.initials: LU
authors.lastname: Nwakanma
authors.forename: Eric S
authors.initials: ES
authors.lastname: Weiss
authors.forename: Vincent L
authors.initials: VL
authors.lastname: Gott
authors.forename: William A
authors.initials: WA
authors.lastname: Baumgartner
authors.forename: John V
authors.initials: JV
authors.lastname: Conte
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D019540:Area Under Curve; D002315:Cardiopulmonary Bypass; D003131:Combined Modality Therapy; D015897:Comorbidity; D001026:Coronary Artery Bypass; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D012372:ROC Curve; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000706:statistics & numerical data; D012720:Severity of Illness Index