Prospective validation of the EuroSCORE II risk model in a single Dutch cardiac surgery centre

Hogervorst, Esther K.; Rosseel, Peter; Watering, Leo M.G. van de; Brand, Anneke; Bentala, Mohamed; Meer, Bernard; Bom, Johanna G. van der

doi:10.1007/s12471-018-1161-x

Cited by 19 publications

(15 citation statements)

References 24 publications

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“…In 2012, the EuroSCORE research team proposed a new system—EuroSCORE II [ 13 ]. However, with the continuous advancement of surgical techniques and the increasing amount of cardiac surgery worldwide, EuroSCORE II will overestimate or underestimate the risk of death in patients undergoing cardiac surgery [ 14 – 19 ]. The performance of the EuroSCORE II was poor among patients with the lower predicted mortality [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Predictive ability of EuroSCORE II integrating cardiactroponin T in patients undergoing OPCABG

Shan

et al. 2020

BMC Cardiovasc Disord

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Background Preoperative risk evaluation systems are significant and important to the allocation of medical resources and the communication between doctors and patients. The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is widely used in clinical practice. Cardiac troponin T (cTnT) can specifically and accurately reflect myocardial injury. Whether EuroSCORE II can improve the predictive power after integrating with cTnT is still unclear. This study was a retrospective single center study designed to assess the predictive ability of EuroSCORE II integrated with cTnT for patients undergoing isolated off-pump coronary artery bypass grafting (OPCABG). Methods This retrospective and observational cohort study included 1887 patients who underwent first isolated OPCABG. cTnT was detected within 48 h before operation in each patient. According to myocardial injury, patients were divided by cTnT into 4 stages. A new risk evaluation system was created through logistic regression with EuroSCORE II and myocardial injury classification as covariates. Then the two risk evaluation systems were comparatively assessed by regression analysis, receiver operator characteristic curves, net reclassification index, Bland–Altman plots and decision curve analysis. Results There were 43 in-hospital deaths, with a mortality of 2.30% (43/1887). The logistic regression analysis showed that preoperative myocardial injury classification was a significant risk factor for in-hospital mortality in both total cohort (OR 1.491, 95%CI 1.049–2.119) and subsets (OR 1.761, 95%CI 1.102–2.814). The new risk evaluation system has higher calibration and discrimination power than EuroSCORE II, both for overall cohort and subsets. Especially, the new system has obvious advantages in discrimination power in the subset of acute myocardial infarction (AUC 0.813 vs. 0.772, 0.906 vs. 0.841, and 0.715 vs. 0.646, respectively). Conclusions Both myocardial injury classification and EuroSCORE II are independent risk factors of in-hospital mortality in OPCABG patients. The new risk evaluation system has higher predictive ability than EuroSCORE II, especially in patients with a recent history of AMI.

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Section: Discussionmentioning

confidence: 99%

Predictive ability of EuroSCORE II integrating cardiactroponin T in patients undergoing OPCABG

Shan

et al. 2020

BMC Cardiovasc Disord

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“…Similarly, in a single-center validation study in Dutch, the observed mortality was 2.4%, while both the ESA and ESL overestimated mortality (median predictive mortality of ESA and ESL: 5.0% and 10.7%, respectively), and ESII underestimated mortality (median predictive mortality: 1.6%). [15] It is important to point out that the ESL and ESII tend to overestimate even the risk of minimally invasive cardiac surgery (MICS). [18,19] Margaryan et al [18] reported that the ESII is not optimally calibrated for MICS and should be avoided in high-risk patients of more than 8% estimated morality.…”

Section: Discussionmentioning

confidence: 99%

Perioperative risk assessment with Euroscore and Euroscore II in patients with coronary artery or valvular disease

Czub¹,

Cacko²,

Gawałko

et al. 2018

Medicine

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Nowadays, both the European System for Cardiac Operative Risk Evaluation (EuroSCORE) logistic (ESL) and EuroSCORE II (ESII) models are used worldwide in predicting in-hospital mortality after cardiac operation. However, these scales are based on different populations and represent different medical approaches. The aim of the study was to assess the effectiveness of the ESL and the ESII risk scores in predicting in-hospital death and prolonged hospitalization in intensive care unit (ICU) after coronary artery bypass grafting (CABG), aortic valve replacement (AVR), and mitral valve replacement (MVR) by comparison of an estimated risk and a real-life observation at a reference cardiac surgery unit.This retrospective study was based on medical records of patients who underwent a CABG, AVR, or MVR at a reference cardiac surgery unit in a 2-year period. Primary endpoint was defined as in-hospital death. Secondary endpoint was a prolonged hospitalization at the ICU, defined as longer than 3 days.The study encompassed 586 patients [114 (23.1%) female, mean age 65.8 ± 10.5 years], including 493 patients undergoing CABG, 66 patients undergoing AVR, and 27 patients undergoing MVR. The ESL and ESII risk scores were higher in MVR subgroup (31.7% ± 30.5% and 15.3% ± 19.4%) and AVR subgroup (9.7% ± 11.6% and 3.2% ± 4.2%) than in CABG subgroup (6.9% ± 10.4% and 2.5% ± 4.1%; P < .001). Subgroups of patients were significantly different in terms of clinical, biochemical, and echocardiography factors. Primary endpoint occurred in 36 (6.1%) patients: 21 (4.3%), 7 (10.6%), and 8 (29.7%) in CABG, AVR, and MVR subgroups, respectively. The ESII underestimated the risk of mortality. Secondary endpoint occurred in 210 (35.8%) patients: 172 (34.9%), 22 (33.4%), and 16 (59.3%) in CABG, AVR, and MVR subgroups, respectively.In the study, the perioperative risk estimated with the ESL and the ESII risk scores was compared with a real-life outcome among over 500 patients. Regardless of the type of surgery, result in the ESL was better correlated with the risk of in-hospital death.

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“…Нині для визначення ризику коронарного та клапанного втручання використовують шкали ризику EuroSCORE -Європейська система оцінювання кардіального операційного ризику (European System for Cardiac Operative Risk Evaluation): адитивний EuroSCORE (ESA), логістичний -logistic (ESL) та EuroSCORE II (ESII) [4,5]. Багато авторів використовують модель EuroSCORE (ES) в Європі та підвищили її значення в диференціації пацієнтів за періопераційним ризиком [6][7][8][9]. Однак автори статей останніх років відзначають незадовільне калібрування цих ал- [9].…”

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“…Багато авторів використовують модель EuroSCORE (ES) в Європі та підвищили її значення в диференціації пацієнтів за періопераційним ризиком [6][7][8][9]. Однак автори статей останніх років відзначають незадовільне калібрування цих ал- [9]. Необхідно зазначити, що ESL та ESII, як правило, завищують ризик при малоінвазивних кардіохірургічних операціях (MICS) [10].…”

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Coronary Bypass Grafting for High-Risk Patients (Literature review)

Gogayeva

2020

ujcvs

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Ischemic heart disease still remains one of the leading causes) of morbidity and mortality of population of high-developed countries. Annually we notice an increase of coronary artery bypass grafting (CABG) procedures, especially for high-risk patients. Objective. To perform literature review of CABG for high-risk patients. Results. According to literature data’s we reviewed and compared risks scores used in cardiovascular surgery for determination of patients’ severity and probability of death. The basic errors of the EuroSCORE I, II scales and the possibilities of their use in minimally invasive surgery were identified. According to modern randomized clinical trials (RCTs) comparing the OPCAB (off-pump coronary artery bypass (OPCAB) and ONCAB (on-pump coronary artery bypass) techniques, there is no clear difference in complications. Despite the small percentage of high-risk patients in RCTs (18% in the CORONARY trial), many authors consider that OPCAB has a lot of advantages for high-risk patients. Better results were obtained in elderly patients with neurocognitive disorders, porcelain aorta, diabetes mellitus, kidney insufficiency and low ejection fraction of left ventricle. Kowalewski et al. studied high-risk patients and used special statistical methods to compare patients by their risk profile. They concluded that high-risk patients have linear correlation between risk profile and increase in benefits from OPCAB: all-cause mortality (P<0.01), myocardial infarction (P<0.01) and stroke (P<0.01). According to Raja, Shahzad G., total arterial revascularization with all its advantages and improvement of survival, reduction in the number of repeated revascularizations and low stroke rates can be considered as the Holy Grail in myocardial revascularization. However, larger randomized research is needed to justify this status. Followers of ONCAB technique claim that OPCAB leads to incomplete revascularization, poor quality of grafts and repeated hospitalizations and revascularization. It should be noted that high-risk patients should be operated in expert centres by the team of skilled heart surgeons, anaesthesiologists and with competent medical support of cardiologist.

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Prospective validation of the EuroSCORE II risk model in a single Dutch cardiac surgery centre

Cited by 19 publications

References 24 publications

Predictive ability of EuroSCORE II integrating cardiactroponin T in patients undergoing OPCABG

Predictive ability of EuroSCORE II integrating cardiactroponin T in patients undergoing OPCABG

Perioperative risk assessment with Euroscore and Euroscore II in patients with coronary artery or valvular disease

Coronary Bypass Grafting for High-Risk Patients (Literature review)

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