European Heart Journal Advance Access originally published online on January 13, 2009
European Heart Journal 2009 30(3):297-304; doi:10.1093/eurheartj/ehn581
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Performance of EuroSCORE in CABG and off-pump coronary artery bypass grafting: single institution experience and meta-analysis
1 Department of Cardiac Surgery, Unit for Clinical Research in Atherothrombosis, Centro Cardiologico Monzino IRCCS, University of Milan, Via Parea, 4, 20138 Milan, Italy
2 Department of Radiology, MC 2026, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL, USA
3 Department of Anesthesia and Intensive Care, Centro Cardiologico Monzino IRCCS, Milan, Italy
4 Department of Cardiovascular Surgery, Clermont-Ferrand University, Clermont-Ferrand, France
Received 22 September 2008; revised 24 November 2008; accepted 4 December 2008; online publish-ahead-of-print 13 January 2009.
* Corresponding author. Tel: +39 02 580021, Fax: +39 02 58011194, Email: alessandro.parolari{at}cardiologicomonzino.it
Aims: To assess EuroSCORE performance in predicting in-hospital mortality in on-pump coronary artery bypass grafting (CABG) and off-pump coronary artery bypass grafting (OPCAB).
Methods and results: Additive and logistic EuroSCORE were computed for consecutive patients undergoing CABG (n = 3440, 75%) or OPCAB (n = 1140, 25%) at our hospital from 1999 to September 2007. The areas under the receiver operating characteristic (ROC) curves (AUCs) were used to describe performance and accuracy. No difference in performance between CABG and OPCAB and between additive and logistic EuroSCORE (additive EuroSCORE AUCs of 0.808 and 0.779 for CABG and OPCAB, respectively; logistic EuroSCORE AUCs of 0.813 and of 0.773 for CABG and OPCAB, respectively) was found, although a marked tendency to overpredict mortality by both models was evident. A meta-analysis of previously published data was done, and a total of eight studies representing 19 212 and 5461 patients undergoing CABG and OPCAB, respectively, met inclusion criteria. Meta-analysis confirmed similar performance of EuroSCORE in CABG and OPCAB: estimated AUCs were 0.767 and 0.766 for CABG and OPCAB, respectively, with an estimated difference of 0.001 (95% CI –0.061 to 0.063).
Conclusion: Additive and logistic EuroSCORE algorithms performed similarly, and cumulative evidence suggests comparable performance in CABG and OPCAB procedures; both risk models, however, significantly overestimated mortality.
Key Words: EuroSCORE • CABG • OPCAB • ROC analysis • Meta-analysis