title: EuroSCORE II and the importance of a local model, InsCor and the future SP-SCORE.
abstract: BACKGROUND
  The most widely used model for predicting mortality in cardiac surgery was recently remodeled, but the doubts regarding its methodology and development have been reported.
  
  
  OBJECTIVE
  The aim of this study was to assess the performance of the EuroSCORE II to predict mortality in patients undergoing coronary artery bypass grafts or valve surgery at our institution.
  
  
  METHODS
  One thousand consecutive patients operated on coronary artery bypass grafts or valve surgery, between October 2008 and July 2009, were analyzed. The outcome of interest was in-hospital mortality. Calibration was performed by correlation between observed and expected mortality by Hosmer Lemeshow. Discrimination was calculated by the area under the ROC curve. The performance of the EuroSCORE II was compared with the EuroSCORE and InsCor (local model).
  
  
  RESULTS
  In calibration, the Hosmer Lemeshow test was inappropriate for the EuroSCORE II (P=0.0003) and good for the EuroSCORE (P=0.593) and InsCor (P=0.184). However, the discrimination, the area under the ROC curve for EuroSCORE II was 0.81 [95% CI (0.76 to 0.85), P<0.001], for the EuroSCORE was 0.81 [95% CI (0.77 to 0.86), P<0.001] and for InsCor was 0.79 [95% CI (0.74-0.83), P<0.001] showing up properly for all.
  
  
  CONCLUSIONS
  The EuroSCORE II became more complex and resemblance to the international literature poorly calibrated to predict mortality in patients undergoing coronary artery bypass grafts or valve surgery at our institution. These data emphasize the importance of the local model.
authors.forename: Luiz Augusto Ferreira
authors.initials: LA
authors.lastname: Lisboa
authors.forename: Omar Asdrubal Vilca
authors.initials: OA
authors.lastname: Mejia
authors.forename: Luiz Felipe Pinho
authors.initials: LF
authors.lastname: Moreira
authors.forename: Luís Alberto Oliveira
authors.initials: LA
authors.lastname: Dallan
authors.forename: Pablo Maria Alberto
authors.initials: PM
authors.lastname: Pomerantzeff
authors.forename: Luís Roberto Palma
authors.initials: LR
authors.lastname: Dallan
authors.forename: Maria Raquel B
authors.initials: MR
authors.lastname: Massoti
authors.forename: Fabio B
authors.initials: FB
authors.lastname: Jatene
mesh_terms: D002138:Calibration / Q000592:standards; D001026:Coronary Artery Bypass / Q000401:mortality*; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D012016:Reference Values; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity