EuroSCORE II and the importance of a local model,InsCor and the future SP-SCORE

Introduction

The most widely used model for predicting mortality in cardiac surgery wasrecently remodeled, but the doubts regarding its methodology and development havebeen reported.

Objective

The aim of this study was to assess the performance of the EuroSCORE II to predictmortality in patients undergoing coronary artery bypass grafts or valve surgery atour institution.

Methods

One thousand consecutive patients operated on coronary artery bypass grafts orvalve surgery, between October 2008 and July 2009, were analyzed. The outcome ofinterest was in-hospital mortality. Calibration was performed by correlationbetween observed and expected mortality by Hosmer Lemeshow. Discrimination wascalculated by the area under the ROC curve. The performance of the EuroSCORE IIwas compared with the EuroSCORE and InsCor (local model).

Results

In calibration, the Hosmer Lemeshow test was inappropriate for the EuroSCORE II(P=0.0003) and good for the EuroSCORE(P=0.593) and InsCor (P=0.184). However, thediscrimination, the area under the ROC curve for EuroSCORE II was 0.81 [95% CI(0.76 to 0.85), P<0.001], for the EuroSCORE was 0.81 [95% CI(0.77 to 0.86), P<0.001] and for InsCor was 0.79 [95% CI(0.74-0.83), P<0.001] showing up properly for all.

Conclusion

The EuroSCORE II became more complex and resemblance to the internationalliterature poorly calibrated to predict mortality in patients undergoing coronaryartery bypass grafts or valve surgery at our institution. These data emphasize theimportance of the local model.