The EuroSCORE: A neglected measure of medium-term survival following cardiac surgery

Abstract

OBJECTIVES EuroSCORE is used to predict operative mortality following cardiac surgery. There are limited data to assess the ability of EuroSCORE to predict medium-to long-term survival. We aimed to test the ability of EuroSCORE to predict mid-term survival following cardiac surgery. METHODS We analysed prospectively collected data from all patients undergoing cardiac surgery in an urban tertiary cardiac centre over a 6-year period. All-cause mortality following cardiac surgery was determined via Office of National Statistics data. Patients were grouped into all comers, coronary artery bypass graft (CABG), isolated aortic valve replacement (AVR), isolated mitral valve repair and replacement (MVR) and combined AVR/MVR and CABG. Each group was separated into EuroSCORE quartiles. Kaplan-Meier curves were used to calculate 6-year actuarial survival. Log-rank test was used to calculate the P-value. C-statistic discriminated the ability of the EuroSCORE to predict medium-term survival. RESULTS A total of 9022 consecutive patients were identified. The mean age was 66.86 years, 73.7% were male. The cases were grouped according to their additive EuroSCORE into 0-5 (n = 5369), 6-10 (n = 3059), 11-15 (n = 506) and >15 (n = 93). Median follow-up was 2.92 years. The 6-year survival was 88.5, 71.8, 52.5 and 39.5%, respectively. The P-value for all operative categories was significant. The C-statistic was 0.68 (all comers), 0.72 for isolated MVR, 0.65 (isolated CABG), 0.62 (isolated AVR) and 0.69 (combined AVR/MVR and CABG). CONCLUSIONS Additive EuroSCORE may be used to predict medium-term survival in patients undergoing cardiac surgery; increasing additive EuroSCORE resulting in significant decreases in survival. It is a good predictive tool for patients undergoing isolated MVR and a fair tool for patients undergoing the remaining operative procedures studied.