Poor performances of EuroSCORE and CARE score for prediction of perioperative mortality in octogenarians undergoing aortic valve replacement for aortic stenosis.
OBJECTIVE
Although results of cardiac surgery are improving, octogenarians have a higher procedure-related mortality and more complications with increased length of stay in ICU. Consequently, careful evaluation of perioperative risk seems necessary. The aims of our study were to assess and compare the performances of EuroSCORE and CARE score in the prediction of perioperative mortality among octogenarians undergoing aortic valve replacement for aortic stenosis and to compare these predictive performances with those obtained in younger patients.


METHODS
This retrospective study included all consecutive patients undergoing cardiac surgery in our institution between November 2005 and December 2007. For each patient, risk assessment for mortality was performed using logistic EuroSCORE, additive EuroSCORE and CARE score. The main outcome measure was early postoperative mortality. Predictive performances of these scores were assessed by calibration and discrimination using goodness-of-fit test and area under the receiver operating characteristic curve, respectively.


RESULTS
During this 2-year period, we studied 2117 patients, among whom 134/211 octogenarians and 335/1906 nonoctogenarians underwent an aortic valve replacement for aortic stenosis. When considering patients with aortic stenosis, discrimination was poor in octogenarians and the difference from nonoctogenarians was significant for each score (0.58, 0.59 and 0.56 vs. 0.82, 0.81 and 0.77 for additive EuroSCORE, logistic EuroSCORE and CARE score in octogenarians and nonoctogenarians, respectively, P < 0.05). Moreover, in the whole cohort, logistic EuroSCORE significantly overestimated mortality among octogenarians.


CONCLUSIONS
Predictive performances of these scores are poor in octogenarians undergoing cardiac surgery, especially aortic valve replacement. Risk assessment and therapeutic decisions in octogenarians should not be made with these scoring systems alone.
Département d'Anesthésie-Réanimation-Chirurgicale, Département d'Epidémiologie, Biostatistique et Recherche Clinique, Hospital Bichat-Claude Bernard (APHP), Faculté Xavier Bichat, Université Paris 7 (GB), Paris, France.
Vibol
V
Chhor
Sybille
S
Merceron
Sylvie
S
Ricome
Gabriel
G
Baron
Omar
O
Daoud
Marie-Pierre
MP
Dilly
Benjamin
B
Aubier
Sophie
S
Provenchere
Ivan
I
Philip
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000601:surgery*; D015331:Cohort Studies; D005060:Europe; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000401:mortality*; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012107:Research Design / Q000592:standards*; D012189:Retrospective Studies; D012307:Risk Factors