European Heart Journal Advance Access originally published online on November 24, 2008
European Heart Journal 2009 30(1):74-80; doi:10.1093/eurheartj/ehn523
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Overestimation of aortic valve replacement risk by EuroSCORE: implications for percutaneous valve replacement
1 Department of Thoracic and Cardiovascular Surgery, University of Essen, Hufelandstr. 55, 45147 Essen, Germany
2 Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
3 Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
4 Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
Received 24 August 2007; revised 10 October 2008; accepted 29 October 2008; online publish-ahead-of-print 24 November 2008.
* Corresponding author. Tel: +49 201 723 4901, Fax: +49 201 723 5451, Email: brigitte.osswald{at}uk-essen.de
Aims: The EuroSCORE has been proposed to identify patients at high risk for surgical aortic valve replacement (AVR) and estimate for them the risk-benefit of percutaneous valve replacement. The aim of our study was to investigate the validity of this proposal.
Methods and results: From 1994 to March 2006, 1545 consecutive patients with aortic stenosis underwent isolated surgical AVR at the Department of Cardiac Surgery of Heidelberg. Both additive and logistic EuroSCOREs were calculated for each patient and summed for expected 30-day mortality. Expected and observed mortalities were compared, particularly with respect to ‘high-risk’ status and era of operation. Overall, 30-day mortality was low (34/1545, 2.2%) and substantially overestimated by both additive (6.1%) and logistic (9.3%) EuroSCOREs. Although both EuroSCOREs stratified patients monotonically with respect to mortality risk, high-risk patients had a 3.6% mortality (29/833), whereas additive and logistic EuroSCOREs predicted 8.3 and 14.8%. Indeed, none of the 71 patients with a EuroSCORE of 11–20 (extremely high risk) died. The more recent the era of operation, the more pronounced was the discrepancy between expected and observed mortalities.
Conclusion: Although the EuroSCORE still successfully stratifies patients undergoing surgical AVR relative to 30-day mortality, it has become increasingly uncalibrated with absolute risk, resulting in overestimation of 30-day mortality. Inaccurately predicted mortality, especially in ‘high-risk’ patients, renders it unsuitable for assessing risk reduction of percutaneous valve replacement.
Key Words: Aortic valve disease • Risk adjustment • High-risk patients
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  E. Manasse Cooks and recipes Eur. J. Cardiothorac. Surg., November 1, 2009; 36(5): 787 - 790. [Full Text] [PDF]
|
|
|
|
|
|
T. M. Dewey and M. A. Herbert Editorial comment: Predicting operative risk: a worthy task -- an elusive goal Eur. J. Cardiothorac. Surg., November 1, 2009; 36(5): 797 - 798. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Thielmann, D. Wendt, H. Eggebrecht, P. Kahlert, P. Massoudy, M. Kamler, R. Erbel, H. Jakob, and S. Sack Transcatheter aortic valve implantation in patients with very high risk for conventional aortic valve replacement. Ann. Thorac. Surg., November 1, 2009; 88(5): 1468 - 1474. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Wendt, B. R. Osswald, K. Kayser, M. Thielmann, P. Tossios, P. Massoudy, M. Kamler, and H. Jakob Society of Thoracic Surgeons score is superior to the EuroSCORE determining mortality in high risk patients undergoing isolated aortic valve replacement. Ann. Thorac. Surg., August 1, 2009; 88(2): 468 - 474. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Al-Attar, W. Ghodbane, D. Himbert, C. Rau, R. Raffoul, D. Messika-Zeitoun, E. Brochet, A. Vahanian, and P. Nataf Unexpected complications of transapical aortic valve implantation. Ann. Thorac. Surg., July 1, 2009; 88(1): 90 - 94. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Al-Attar, D. Himbert, F. Descoutures, B. Iung, R. Raffoul, D. Messika-Zeitoun, E. Brochet, F. Francis, H. Ibrahim, A. Vahanian, et al. Transcatheter Aortic Valve Implantation: Selection Strategy Is Crucial for Outcome. Ann. Thorac. Surg., June 1, 2009; 87(6): 1757 - 1763. [Abstract] [Full Text] [PDF]
|
|
E-letters:
Read all E-letters
- RISK SCORES AND OVERESTIMATION OF THE OPERATIVE MORTALITY RISK IN AORTIC VALVE REPLACEMENT
- Marco Ranucci, et al.
- European Heart Journal, 13 Oct 2009 [Full text]
- The Reliability of Scores
- Brigitte R. Osswald
- European Heart Journal, 13 Oct 2009 [Full text]