071PERFORMANCE OF THE EUROSCORE II IN A LARGE US DATABASE AND IMPLICATIONS FOR PATIENT SELECTION IN CLINICAL TRIALS

• Published in: Interactive cardiovascular and thoracic surgery Vol. 17; no. suppl_2; p. S86
• Main Authors: Osnabrugge, R., Speir, A.M., Head, S., Fonner, C.E., Fonner, E., Kappetein, A.P., Rich, J.B.
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01.10.2013
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivt372.71

Objectives: Validation studies of the EuroSCORE II have been limited to European datasets. Therefore, the aims of this study were to assess the performance of the EuroSCORE II in a large multicentre US database, and compare it with the Society of Thoracic Surgery (STS) score. In addition, implications for patient selection in transcatheter versus surgical aortic valve replacement (AVR) trials were explored. Methods: The EuroSCORE II was calculated for 52 697 patients from a multi-institutional statewide database of all cardiac surgeries performed since 2000. Model performance was assessed using c-statistics, observed versus expected (O:E) ratios and calibration plots. Analyses were performed for isolated coronary artery bypass grafting (CABG; n = 43 917), AVR (n = 4141), AVR + CABG (n = 3646), and mitral valve repair (MVR; n = 993). Results: Overall 30-day mortality was 2.14%. Discrimination in CABG was worse with the EuroSCORE II (c = 0.76 vs STS score 0.81, P < 0.001), and similar in AVR (0.71 vs STS score 0.73, P = 0.59), AVR + CABG (0.69 vs STS 0.71, P = 0.49), and MVR (0.72 vs STS score 0.80, P = 0.16). Calibration of the EuroSCORE II was worse in CABG (O:E ratio = 0.61 vs STS score 0.81), similar in AVR + CABG (0.69 vs STS score 0.74) and MVR (0.64 vs STS score 0.66), while EuroSCORE II was more accurate in AVR (0.89 vs STS score 0.70). Transcatheter AVR trials aimed at patients with an estimated 4-10% risk of mortality are actually including patients with an estimated risk of 2.7-6.8% (STS score) or 3.0-7.5% (EuroSCORE II). Conclusions: In a large US cohort, the EuroSCORE II was outperformed by the STS score in CABG, while it may be a reasonable alternative in other procedures. Patients enrolled in ongoing transcatheter AVR trials are at lower risk than anticipated.