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Ann Thorac Surg 2004;77:1235-1239
© 2004 The Society of Thoracic Surgeons

Original article: cardiovascular

Early mortality in coronary bypass surgery: the EuroSCORE versus The Society of Thoracic Surgeons risk algorithm

Johan Nilsson, MDa*, Lars Algotsson, MD, PhDb, Peter Höglund, MD, PhDc, Carsten Lührs, MDa, Johan Brandt, MD, PhDa

a Department of Cardiothoracic Surgery, University Hospital, Lund, Sweden
b Department of Cardiothoracic Anesthesiology, Heart and Lung Center, University Hospital, Lund, Sweden
c Department of Clinical Pharmacology, University Hospital, Lund, Sweden

Accepted for publication August 28, 2003.

* Address reprint requests to Dr Nilsson, Department of Cardiothoracic Surgery, Heart and Lung Center, University Hospital, SE 221 85 Lund, Sweden.
e-mail: johan.nilsson{at}thorax.lu.se

BACKGROUND: We compare two widely used risk algorithms for coronary bypass surgery: The European System for Cardiac Operative Risk Evaluation (EuroSCORE) and The Society of Thoracic Surgeons (STS) risk stratification algorithm.

METHODS: Risk factors for all adult patients undergoing heart surgery at the University Hospital of Lund between 1996 and 2001 were collected prospectively at preoperative admission. Predictive accuracy for 30-day mortality was assessed by comparing the observed and the expected mortality for equal-sized quintiles of risk by using the Hosmer-Lemeshow goodness-of-fit test. The discriminatory power was evaluated by calculating the areas under receiver operating characteristics (ROC) curves.

RESULTS: The study included 4497 coronary artery bypass-only operations. The average age was 66.4 ± 9.3 years (range 31 to 90 years). Most patients were men (77.0% versus 23.0%). The actual 30-day mortality was 1.89%. The Hosmer-Lemeshow goodness-of-fit test gave a p value of 0.81 (EuroSCORE) and 0.83 (STS), which indicates a good accuracy of both models. The area under the ROC curve was 0.84 (95% confidence interval [CI] 0.80 to 0.88) for EuroSCORE and 0.71 (95% CI 0.66 to 0.77) for STS. The discriminatory power (area under the ROC curve) was significantly larger for EuroSCORE compared with STS (p < 0.00005).

CONCLUSIONS: In this large, single institution study the additive EuroSCORE algorithm had a significantly better discriminatory power to predict 30-day mortality than the STS risk algorithm for patients undergoing coronary artery bypass.




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