The Impact of EuroSCORE II Risk Factors on Prediction of Long-Term Mortality

Fabio Barili, Davide Pacini, Mariangela D'Ovidio, Nicholas C. Dang, Francesco Alamanni, Roberto Di Bartolomeo, Claudio Grossi, Marina Davoli, Danilo Fusco, Alessandro Parolari

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Abstract

Background The European System for Cardiac Operation Risk Evaluation (EuroSCORE) II has not been tested yet for predicting long-term mortality. This study was undertaken to evaluate the relationship between EuroSCORE II and long-term mortality and to develop a new algorithm based on EuroSCORE II factors to predict long-term survival after cardiac surgery. Methods Complete data on 10,033 patients who underwent major cardiac surgery during a 7-year period were retrieved from three prospective institutional databases and linked with the Italian Tax Register Information System. Mortality at follow-up was analyzed with time-to-event analysis. Results The Kaplan-Meier estimates of survival at 1 and 5 were, respectively, 95.0% ± 0.2% and 84.7% ± 0.4%. Both discrimination and calibration of EuroSCORE II decreased in the prediction of 1-year and 5-year mortality. Nonetheless, EuroSCORE II was confirmed to be an independent predictor of long-term mortality with a nonlinear trend. Several EuroSCORE II variables were independent risk factors for long-term mortality in a regression model, most of all very low ejection fraction (less than 20%), salvage operation, and dialysis. In the final model, isolated mitral valve surgery and isolated coronary artery bypass graft surgery were associated with improved long-term survival. Conclusions The EuroSCORE II cannot be considered a direct estimator of long-term risk of death, as its performance fades for mortality at follow-up longer than 30 days. Nonetheless, it is nonlinearly associated with long-term mortality, and most of its variables are risk factors for long-term mortality. Hence, they can be used in a different algorithm to stratify the risk of long-term mortality after surgery.

Original languageEnglish
Pages (from-to)1296-1303
Number of pages8
JournalAnnals of Thoracic Surgery
Volume102
Issue number4
DOIs
Publication statusPublished - Oct 1 2016

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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    Barili, F., Pacini, D., D'Ovidio, M., Dang, N. C., Alamanni, F., Di Bartolomeo, R., Grossi, C., Davoli, M., Fusco, D., & Parolari, A. (2016). The Impact of EuroSCORE II Risk Factors on Prediction of Long-Term Mortality. Annals of Thoracic Surgery, 102(4), 1296-1303. https://doi.org/10.1016/j.athoracsur.2016.04.017