心瓣膜手术风险预测模型的现状与进展

心脏瓣膜病是目前最常见的三大心脏疾病之一,需接受心瓣膜手术的患者均逐年增加。由于心瓣膜手术较高的病死率、手术数量的不断增加及政府相应卫生经济负担的逐步加重,促使世界各国根据自身的心瓣膜手术数据建立相应的手术风险预测模型,以规范术前风险评估工作,进一步降低围术期病死率,提高心瓣膜手术成功率。在过去10多年时间里,瓣膜外科领域相继出现了一系列高质量的风险预测模型,包括美国胸外科医师协会（theSociety of Thoracic Surgeons,STS）、北美胸科医师协会所属心脏外科数据库（the Society of Thoracic Surgeons’National Cardiac Database,STS NCD）、纽约心脏手术数据报告系统（New York Cardiac Surgery Reporting System,NYCSRS）、欧洲心脏手术风险评估系统（the European System for Cardiac Operative Risk Evaluation,EuroSCORE）、北英格兰心血管疾病研究协作组（the Northern New England Cardiovascular Disease Study Group,NNECDSG）、美国退役军人心脏手术质量改进项目（the Veterans Affairs Continuous Improvement in Cardiac Surgery Study,VACICSP）、北美胸科医师协会所属心脏外科数据库（Database of the Society of Cardiothoracic Surgeons of GreatBritain and Ireland,SCTS）和英格兰西北部心脏干预治疗质量改善项目（the North West Quality ImprovementProgramme in Cardiac Interventions,NWQIP）。我们回顾了1999~2009年基于国外多中心数据发布的心瓣膜手术风险预测模型,从模型的发布时间、数据来源、适用范围及相关危险因素等方面进行综述。     

冠状动脉旁路移植术风险预测模型的研究进展

风险评估模型不仅可以区分患者疾病的严重程度,还能协助临床医生要按照患者的个体特征来选择最适合患者的临床策略,能够帮助患者及家属更好理解目前治疗策略及其存在的治疗风险,使他们获得知情权。目前国内外有关冠状动脉旁路移植术应用最广泛的手术风险评估模型有:美国胸外科医师协会心脏手术风险预测模型(the Society of Thoracic Surgeons Score,STS Score)、欧洲心脏手术风险预测模型(the European System for Cardiac Operative Risk Evaluation,EuroSCORE)、中国冠状动脉旁路移植术风险预测模型(Sino System for Coronary Operative Risk Evaluation,SinoSCORE)。本文旨在对冠状动脉旁路移植术风险预测方法的最新研究进展进行综述。     

高手术风险冠状动脉旁路移植术早期临床结果分析

目的采用心脏手术风险评估欧洲系统（European System for Cardiac Operative Risk Evaluation，EuroSCORE）评估高手术风险冠状动脉旁路移植术（CABG）患者的早期临床结果。方法将2004年2～9月在我科行CABG的84例患者按EuroSCORE评分分为高手术风险组（≥6,40例）和中低手术风险组（0～5,44例）；记录两组手术方案、术后并发症发生情况；在手术后应用急性生理学和慢性健康状况评分Ⅲ（APACHEⅢ）和序贯器官衰竭评估（SOFA）对患者进行危重症评估。分析比较两组患者早期临床结果。结果高手术风险组的手术死亡率、需长时间重症监护治疗比率、术后并发症发生率和危重程度均高于中低手术风险组。在总体水平上A0，A1，Amax和S1，Smax均与standard EuroSCORE（P〈0．01）和logistic EuroSCORE（P〈0．05）分别呈正相关；在不同风险度比较时，仅在高手术风险组中standard EuroSCORE与A1，Anax，S1和Smax呈正相关（P〈0．05）；logistic EuroSCORE仅与Amax相关（P〈0．05）。结论EuroSCORE系统在总体上能够很好地评估心脏手术风险，对高危患者更敏感。术前准确对患者状况进行评估，术中完善心肌保护、有效的心肌供血重建和彻底心内畸形矫正，术后及时正确的处理可以改善高手术风险患者的预后。     

SinoSCORE对成人心脏手术后院内死亡风险的预测——中国成人心脏外科数据库华西医院数据报告

目的评价中国冠状动脉旁路移植手术风险评估系统(Sino System for Coronary Operative Risk Evalua-tion,SinoSCORE)对华西医院(本中心)成人心脏手术后院内死亡风险的预测价值。方法连续纳入2010年1月至2012年5月进入中国成人心脏外科数据库、本中心2 088例行心脏手术患者的临床资料,比较本中心与中国成人心脏外科数据库中所有患者术前危险因素的差异。计算每例患者的SinoSCORE累计积分,评价SinoSCORE预测本中心患者院内死亡风险的鉴别度和校准度。结果本中心2 088例患者中行冠状动脉旁路移植术(CABG)168例(8.05%),心瓣膜手术1 884例(90.23%),其它手术36例(1.72%)。本中心患者的高脂血症、脑卒中、心血管手术史、肾脏疾病等与中国成人心脏外科数据库中全部患者的差异有统计学意义。本中心患者实际术后院内病死率为2.25%(47/2 088),SinoSCORE预测院内病死率为2.35%(49/2 088)[95%CI(2.18,2.47)]。SinoSCORE预测本中心患者术后院内病死率的校准度(χ2=3.164,P=0.582)和鉴别度[受试者工作特征曲线下面积0.751,95%CI(0.719,0.924)]均较好。结论 SinoSCORE对中国西南地区成人心脏手术后院内死亡风险的预测虽高估风险,但仍适用。     

不同心脏手术风险预测评分系统对中国冠状动脉旁路移植术后患者早期死亡的预测

目的 评价STS评分系统[the Society of Thoracic Surgeons(STS)2008 Cardiac Surgery Risk Models]、欧洲心脏手术风险评估系统(EuroSCORE)、Parsonnet评分系统和美国心脏病学院/美国心脏协会(American College of Car...     

EuroSCORE模型对心瓣膜手术患者死亡风险的预测

目的评价欧洲心脏手术风险评估系统（European System for Cardiac Operative Risk Evaluation,EuroSCORE）模型预测行心脏瓣膜手术患者在院死亡率的准确性。方法收集1998年1月至2008年12月于第二军医大学长海医院因心脏瓣膜疾病行外科治疗4 155例患者的临床资料,其中男1 955例,女2 200例;年龄45.90±13.64岁。先按additive及logistic EuroSCORE两种方法评分,将患者分为低风险（n=981）、中风险（n=2 492）、高风险（n=682）3个亚组,比较全组及各亚组患者的实际与预测死亡率。模型预测的校准度用Hosmer-Lemeshow卡方检验,预测的鉴别度采用受试者工作特征（receiver operating characteristic,ROC）曲线下面积检验。结果 4 155例患者在院死亡205例,实际在院死亡率4.93%;additive EuroSCORE预测死亡率为3.80%,而logisticEuroSCORE为3.30%;提示两种评分方法均低估了实际在院死亡率（χ2=11.13,44.34,P〈0.05）。additiveEuroSCORE对高风险亚组在院死亡预测校准度较高（χ2=3.61,P=0.31）,但对低风险亚组（χ2=0.00,P〈0.01）及中风险亚组（χ2=14.72,P〈0.01）较低;而logistic EuroSCORE对低风险亚组（χ2=1.66,P=0.88）及高风险亚组（χ2=11.71,P=0.11）在院死亡预测准确性均较高,却低估了中风险亚组（χ2=17.48,P〈0.01）的实际在院死亡率。两种评分方法对全组患者在院死亡预测的鉴别度均较差（ROC曲线下面积分别为0.676和0.677）。结论 EuroSCORE模型对本中心心瓣膜手术患者死亡风险预测的准确性较差,不适合本中心心瓣膜手术的风险预测,在今后的临床实践中应慎重使用。     

循证医学手段在睑成形术中的应用

维持资格模块系统（The Maintenance of Certification module series）可为临床医师在其特定专业领域的临床工作带来帮助。本文将对术前评估、麻醉、手术治疗方案、围手术期管理及术后效果方面进行实际测评。临床医师应用此量表将其治疗方法、术后效果和并发症情况与权威的、信息化的资料进行对比。将所获取的信息库（信息资料）以美国整形外科协会维持资格认定过程（Maintenance of Certification process of the American Board of Plastic Surgery）第Ⅱ、第Ⅳ部分为基准,进行自评和基准化测评。本文不准备对这一项目进行详细论述,而是为以后的建立在近期发表文献复习上的深度研究做准备。     

SinoSCORE对老年心血管外科病人的手术风险预测作用

目的 评价中国冠状动脉旁路移植手术评分系统(SinoSCORE)对冠状动脉旁路移植手术(CABG)院内病死率和术后并发症的预测效果.方法 中国心血管外科注册登记研究收集来自全国43家心脏外科中心2007年至2008年接受CABG的9564例病人的临床资料.应用logistic回归的统计学方法建立中国冠状动脉旁路移植术风险评分系统(SinoSCORE).本模型确定了包括年龄大于65岁、术前NYHA心功能分级、慢性肾功能衰竭史、慢性阻塞性肺疾病等11个危险因素.根据SinoSCORE评分将病人分为:低危组(≤1分)、中危组(2～5分)与高危组(≥6分).评价SinoSCORE对CABG院内病死率和术后并发症的预测效果,应用Homser-Lemeshow(HL)拟合优度检验考察SinoSCORE的校准度,应用ROC曲线下面积(AUC)评价SinoSCORE的区分度,并与EuroSCORE进行比较.通过比较观察病死率与预测病死率95%置信区间的差异,评估SinoSCORE对不同危险组病人院内病死率的预测功能.结果 SinoSCORE对CABG手术病死率与术后主要并发症表现出较好的预测效果:手术病死率HL拟合优度检验为P=0.70,AUC=0.80,术后主要并发症:卒中为HL P=0.43,AUC=0.76;肾衰为HL P=0.70,AUC=0.72;通气时间延长(＞24 h)为HL P=0.18,AUC=0.70;多系统衰竭为HL P=0.49,AUC=0.79,效果优于EuroSCORE.在3组不同危险程度的病人中,观察病死率与预测病死率95%置信区间均有较好的重合.结论 SinoSCORE是建立在中国最新的冠脉旁路移植手术临床数据的基础上风险评分系统,预测中国病人的院内死亡与术后并发症的能力优于EuroSCORE,更加适合我国心脏外科领域临床医师应用.

Abstract：

Objective Our study aims to evaluate the performance of Chinese risk stratification system for coronary artery bypass grafting (CABG) in the prediction of in-hospital mortality and major postoperative complications after CABG. Methods Clinical information of 9564 consecutive CABG patients was collected in Chinese Coronary Artery Bypass Grafting Registry which recruited 43 centers over China between 2007 and 2008. Sino System for Coronary Operative Risk Evaluation ( SinoSCORE) was developed using the logistic regression model. The SinoSCORE model was designed to predict in-hospital mortality among patients undergoing coronary artery bypass surgery. The scoring system finally identified 11 risk factors including age over 65, preoperative NYHA stage, chronic renal failure, chronic obstructive pulmonary disease, etc. Cut-off point was defined for SinoSCORE model to distinguish low( SinoSCORE: ≤ 1 ), moderate( SinoSCORE :2 -5 ) and high risk groups(≥6).AUC statistic (receiver operating characteristic curve) was used to test discrimination of SinoSCORE model and we assessed calibration of this model by the Hosmer-Lemeshow goodness-of-fit statistic. The above-mentioned results were compared with the European Risk System in Cardiac Operations (EuroSCORE). And we also assessed the applicability of SinoSCORE model in the prediction of in-hospital mortality among the three different risk groups by comparing the 95% confidence interval (CI) between the morbidity observed with that expected. Results SinoSCORE model showed good performance ( HL P ＞ 0. 05, AUC ＞ 0. 70 ) in the prediction of in-hospital mortality and postoperative complications. Of our study population, calibration by Hosmer-Lemeshow (HL) test for in-hospital mortality was P=0.70, discrimination by area under ROC (AUC) was 0.80. And for major postoperative complications, the risk model SinoSCORE model still turned out good including the following: stroke ( HL P = 0. 43, AUC = 0. 76, renal failure ( HL P = 0. 70, AUC = 0. 72 ), prolonged ventilation ( HL P = 0. 18, AUC = 0.70 ),multiple organ failure( HL P =0.49 ,AUC =0.79). By comparison with EuroSCORE model, SinoSCORE model proved better prediction ability in both the discrimination and calibration based on our research crowd. And during the different danger degree of patients, mortality observations 95% CI and estimated values of 95% CI were very good overlap, which indicated that this model for the three different risk groups are applicable. Conclusion SinoSCORE model is based on the newest clinical date of Chinese patients undergoing CABG. SinoSCORE can be used to predict not only in-hospital mortality, for which it was originally designed, but also postoperative complications. SinoSCORE proved better performance than the EuroSCORE model in Chinese CABG patients and is more suitable for? application? among? domestic cardiac surgery? physicians.     

经食管实时三维超声心动图在心脏外科手术中的应用进展

术中应用经食管超声心动图（TEE）是提高心脏外科手术质量、减少围术期并发症的重要手段,它在清晰显示心脏结构的同时,又不干扰外科操作,已逐渐被心脏外科医师所接受。食管实时三维超声心动图（real-time three-dimensional transesophageal echocardiogram,RT3D-TEE）的问世更是突破了传统二维TEE只能显示单一解剖切面的局限,其能实时显示心脏三维解剖图象,提供整体直观的心脏解剖信息,更能精确分析病变瓣膜的解剖结构,评估心脏容量变化情况,为心脏外科医师术前制定诊疗策略提供依据;为术中介入操作提供实时引导,并对术后疗效作出精确评价。目前,RT3D-TEE已广泛地应用于心脏瓣膜修复手术、先天性心脏病介入治疗、心脏肿瘤切除以及心脏功能评价等领域,本文对其在心脏外科手术中的应用情况进行综述,为其进一步在临床推广应用打下良好的基础。     

EuroSCORE对维吾尔族与汉族患者心脏瓣膜手术死亡风险的预测价值

目的评价欧洲心脏手术风险评估系统(European System for Cardiac Operative Risk Evaluation,EuroSCORE)预测实施心脏瓣膜手术的维吾尔族与汉族患者在院死亡率的准确性。方法分析2012年9月至2013年12月于新疆医科大学第一附属医院因心脏瓣膜疾病行外科治疗的361例患者的临床资料,维吾尔族患者209例,汉族患者152例。先按additive及logisticEuroSCORE两种方法评分,将患者分为低风险、中风险、高风险3个亚组,比较全组及各亚组患者的实际与预测死亡率。模型预测的校准度采用拟合优度检验,预测的鉴别度采用受试者工作特征(ROC)曲线下面积检验。结果全组患者实际在院死亡率为8.03%,维吾尔族患者6.70%,汉族患者9.87%。additiveEuroSCORE与logisticEuroSCORE预测维吾尔族患者在院死亡率分别为4.03%和3.37%,汉族患者为4.43%和3.77%,均低于实际死亡率(P0.01)。全组患者additiveEuroSCORE与logisticEuroSCORE的曲线下面积分别为0.606和0.598,汉族患者分别为0.574和0.553,维吾尔族患者分别为0.609和0.610。结论 EuroSCORE模型对本地区维吾尔族与汉族瓣膜病患者的死亡风险预测准确性较差,不适合心脏瓣膜手术的风险预测,临床应用时需谨慎考虑。     

SinoSCORE对冠状动脉旁路移植术患者生活质量的预测价值

目的 探讨中国冠状动脉旁路移植手术风险评估系统（Sino System for Coronary Operative Risk Evaluation,SinoSCORE）对冠状动脉旁路移植术（CABG）患者生活质量的预测价值。 方法 选取2008年11月至2010年9月在北京大学人民医院行CABG患者共234例,其中男172例,女62例;年龄（63.0±10.1）岁。分别于术前和术后6个月向患者发放SF-36 生活质量调查简表评估患者生活质量。将234例患者根据其SinoSCORE评分分成低危组（≤1分、67例）,中危组（2～5分、77例）和高危组（≥6分、90例）3组。收集所有患者的围手术期资料,使用SinoSCORE对每位患者进行评分,分析SinoSCORE评分与生活质量评分的相关性。 结果 各组患者术后生活质量评分均较术前提高,且差异有统计学意义（P＜0.05）,3组患者生活质量改善程度差异无统计学意义。相关性分析表明,多个维度的生活质量评分与SinoSCORE评分相关（r值：-0.150～0.255,P＜0.05）。线性回归分析显示,术后躯体健康总评分等多个维度与SinoSCORE评分之间有线性关系（P＜0.05）,但相关性较弱（r2＜0.1）。 结论SinoSCORE评分与患者生活质量相关,尤其是在躯体健康方面相关性更强,SinoSCORE有预测CABG患者生活质量的价值,但预测价值有限。     

Risk stratification models for cardiac surgery

A wide variety of risk stratification systems have been developed to quantify the risk of cardiac surgery. Generally, the focus has been on mortality; however, more recently models have been developed that allow the preoperative prediction of the incidence of morbidity, including renal failure, infection, prolonged ventilation, and neurologic deficit. Many of these risk stratification models are developed from large databases of cardiac surgical patients. Patient and surgical factors that are present preoperatively are assessed for their predictive value for postoperative complications. Risk factors that are found to be significant are assigned a specific weight in the overall summation of risk. These models have been used as tools to compare surgeon's results, institutional outcomes, individual patient risk, and within quality improvement programs. This article will focus on the European System for Cardiac Operative Risk Evaluation, the Society of Thoracic Surgeons score, the Parsonnet score, Cleveland Clinic Model, the Bayes model, and the Northern New England Score.     

SinoSCORE对手术风险的评估作用

目的 评价中国冠状动脉旁路移植手术评分系统(SinoSCORE)对冠状动脉旁路移植手术(CABG)院内病死率和术后并发症的预测效果.方法 中国心血管外科注册登记研究收集来自全国43家心脏外科中心2007年至2008年接受CABG的9564例病人的临床资料.应用logistic回归的统计学方法建立中国冠状动脉旁路移植术风险评分系统(SinoSCORE).本模型确定了包括年龄大于65岁、术前NYHA心功能分级、慢性肾功能衰竭史、慢性阻塞性肺疾病等11个危险因素.根据SinoSCORE评分将病人分为:低危组(≤1分)、中危组(2～5分)与高危组(≥6分).评价SinoSCORE对CABG院内病死率和术后并发症的预测效果,应用Homser-Lemeshow(HL)拟合优度检验考察SinoSCORE的校准度,应用ROC曲线下面积(AUC)评价SinoSCORE的区分度,并与EuroSCORE进行比较.通过比较观察病死率与预测病死率95%置信区间的差异,评估SinoSCORE对不同危险组病人院内病死率的预测功能.结果 SinoSCORE对CABG手术病死率与术后主要并发症表现出较好的预测效果:手术病死率HL拟合优度检验为P=0.70,AUC=0.80,术后主要并发症:卒中为HL P=0.43,AUC=0.76;肾衰为HL P=0.70,AUC=0.72;通气时间延长(＞24 h)为HL P=0.18,AUC=0.70;多系统衰竭为HL P=0.49,AUC=0.79,效果优于EuroSCORE.在3组不同危险程度的病人中,观察病死率与预测病死率95%置信区间均有较好的重合.结论 SinoSCORE是建立在中国最新的冠脉旁路移植手术临床数据的基础上风险评分系统,预测中国病人的院内死亡与术后并发症的能力优于EuroSCORE,更加适合我国心脏外科领域临床医师应用.     

Preoperative risk stratification in infective endocarditis. Does the EuroSCORE model work? Preliminary results.

OBJECTIVE: There is an important role for risk prediction in cardiac surgery. Prediction models are useful in decision making and quality assurance. Patients with infective endocarditis (IE) have a particularly high risk of mortality. The aim was to assess the performance of European System for Cardiac Operative Risk Evaluation (EuroSCORE) in IE. METHODS: The additive and logistic EuroSCORE models were applied to all patients undergoing surgery for IE (Duke criteria) between January 1995 and April 2006 within our prospective institutional database. Observed and predicted mortalities were compared. Model calibration was assessed with the Hosmer-Lemeshow test. Model discrimination was tested by determining the area under the receiver operating characteristic (ROC) curve. RESULTS: One hundred and eighty-one consecutive patients undergoing 191 operations were analyzed. Observed mortality was 28.8%. For the entire cohort the mean additive score was 10.4 (additive predicted mortality of 14.2%). The mean logistic predicted mortality was 27.1%. Discriminative power was good for the additive and the logistic models for the entire series. Area under ROC curve were 0.83 (additive) and 0.84 (logistic) for the entire cohort, 0.81 and 0.81 for the aortic position, 0.91 and 0.92 for the mitral position, 0.81 and 0.81 for the native valve, 0.82 and 0.83 for the prosthetic valves, and 0.81 and 0.51 for the gram-positive microorganisms, respectively. CONCLUSIONS: This initial sample may be small; however, additive and logistic EuroSCORE adequately stratify risk in IE. Logistic EuroSCORE has been calibrated in IE, a special group of very high-risk patients. Further studies with larger sample sizes are required to confirm these initial results.     

非体外循环冠状动脉旁路移植术后早期死亡风险预测——SinoSCORE与EuroSCORE评分的对比

目的 比较中国冠状动脉旁路移植手术评分系统(SinoSCORE)和欧洲心脏外科手术风险评分系统(EuroSCORE)对中国人群非体外循环冠状动脉旁路移植(OPCAB)术后早期死亡风险的预测价值.方法 OPCAB病人资料来自中国心血管外科注册登记研究2004-2005年数据库,观察终点为术后院内死亡.分别用SinoSCORE和logistic EuroSCORE两种模型计算病人预计病死率,并与实际病死率比较.校准度采用Hosmer-Lemeshow拟合优度检验,利用 ROC曲线下面积(AUC)评价模型的区分度.结果 4920例病人中73例发生院内死亡,实际病死率1.48%,SinoSCORE模型和EuroSCORE模型预测的病死率分别为2.73%、4.13%.SinoSCORE模型Hosmer-Lemeshow拟合优度检验P=0.636,AUC=0.794;EuroSCORE模型Hosmer-Lemeshowrny拟合优度检验P=0.01,AUC=0.756.SinoSCORE和logistic EuroSCORE两种模型的区分度均较好,但SinoSCORE的校准度明显优于后者,即两种模型均能预测术后死亡,但SinoSCORE对术后病死率的预测更加准确.结论 SinoSCORE模型比EuroSCORE模型更适用于中国非体外循环冠状动脉旁路移植病人术后早期死亡预测.     

Validation of the EuroSCORE model in Australia.

OBJECTIVE: There is an important role for accurate risk prediction models in current cardiac surgical practice. Such models enable benchmarking and allow surgeons and institutions to compare outcomes in a meaningful way. They can also be useful in the areas of surgical decision-making, preoperative informed consent, quality assurance and healthcare management. The aim of this study was to assess the performance of the European System for Cardiac Operative Risk Evaluation (EuroSCORE) model on the Australasian Society of Cardiac and Thoracic Surgeons (ASCTS) patient database. METHODS: The additive and logistic EuroSCORE models were applied to all patients undergoing cardiac surgery at six institutions in the state of Victoria between 1st July 2001 and 4th July 2005 within the ASCTS database who have complete data. The entire cohort and a subgroup of patients undergoing coronary artery bypass grafting (CABG) only were analysed. Observed and predicted mortalities were compared. Model discrimination was tested by determining the area under the receiver operating characteristic (ROC) curve. Model calibration was tested by the Hosmer-Lemeshow chi-square test. RESULTS: Eight thousand three hundred and thirty-one patients with complete data were analysed. There were significant differences in the prevalence of risk factors between the ASCTS and European cardiac surgical populations. Observed mortality was 3.20% overall and 2.00% for the CABG only group. The EuroSCORE models over estimated mortality (entire cohort: additive predicted 5.31%, logistic predicted 8.76%; CABG only: additive predicted 4.25%, logistic predicted 6.19%). Discriminative power of both models was very good. Area under ROC curve was 0.83 overall and 0.82 for the CABG only group. Calibration of both models was poor as mortality was over predicted at nearly all risk deciles. Hosmer-Lemeshow chi-square test returned P-values less than 0.05. CONCLUSIONS: The additive and logistic EuroSCORE does not accurately predict outcomes in this group of cardiac surgery patients from six Australian institutions. Hence, the use of the EuroSCORE models for risk prediction may not be appropriate in Australia. A model, which accurately predicts outcomes in Australian cardiac surgical patients, is required.     

Mortality risk prediction in cardiac surgery: comparing a novel model with the EuroSCORE

Background: Several models for prediction of early mortality after open‐heart surgery have been developed. Our objectives were to develop a local mortality risk prediction model, compare it with the European System for Cardiac Operative Risk Evaluation (EuroSCORE), and investigate whether the addition of intra‐operative variables could enhance the accuracy of risk prediction. Methods: All 5029 patients undergoing open‐heart surgery in 2000–2007 were included in the study. Logistic regression with bootstrap methods was used to develop a pre‐operative risk prediction model for in‐hospital mortality. Next, several intra‐operative variables were added to the pre‐operative model. Calibration and discrimination were assessed, and the model was internally validated for prediction in future datasets. We thereafter compared the pre‐operative model with the additive and logistic EuroSCOREs. Results: Our pre‐operative model included eight risk factors that are routinely registered in our department: age, gender, degree of urgency, operation type, previous cardiac surgery, and renal, cardiac, and pulmonary dysfunction. The model estimated mortality accurately throughout the dataset except in the 1% of patients at extremely high risk, in which mortality was somewhat overestimated. The estimated shrinkage factor was 0.930. The areas under the receiver operating characteristic curve for our pre‐operative model and the logistic EuroSCORE were 0.857(0.823–0.891) and 0.821(0.785–0.857) (P=0.02). There was no significant difference in performance between the pre‐operative and the intra‐operative model (P>0.10). Conclusion: Our pre‐operative model was simple and easy to use, and showed good predictive ability in our population. Internal validation indicated that it would accurately predict mortality in a future dataset.