What question did this study set out to answer?

To determine the accuracy of the logistic EuroSCORE in predicting operative mortality following aortic valve replacement.

July 14, 2009Journal of Cardiothoracic SurgeryOpen Access

The European System for Cardiac Operative Risk Evaluation (EuroSCORE) is not appropriate for withholding surgery in high-risk patients with aortic stenosis: a retrospective cohort study

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: severe aortic stenosis (n=1421). Intervention: Conventional aortic valve replacement (AVR) vs. Predicted mortality by logistic EuroSCORE. Primary outcome: Operative mortality in patients with logistic EuroSCORE > 20 (O/E ratio 0.29, 95% CI 0.15-0.52, p=<0.05).

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Key result

Actual operative mortality in high-risk patients with severe aortic stenosis undergoing aortic valve replacement was significantly lower than predicted by the logistic EuroSCORE (11.4% vs. 38.7%, O/E ratio 0.29).

Why the study?

Does the logistic EuroSCORE accurately predict operative mortality in high-risk patients undergoing conventional aortic valve replacement for severe aortic stenosis?

Key Points

To determine the accuracy of the logistic EuroSCORE in predicting operative mortality following aortic valve replacement.
Retrospective cohort analysis of all consecutive patients (N=1,421) who underwent conventional aortic valve replacement between 1995 and 2005 at a single institution.
Calculated logistic EuroSCORE and determined all-cause operative mortality using provincial vital statistics to assess the ratio of observed to expected mortality.
In high-risk patients with a logistic EuroSCORE > 20 (n=237), actual operative mortality was significantly lower than the predicted rate (11.4% vs. 38.7%; observed/expected ratio 0.29, 95% CI 0.15–0.52, P < 0.05).
EuroSCORE overestimated mortality across all predicted risk strata, and approximately 60% of patients with EuroSCORE > 20 remained alive at 5 years despite increased medium-term mortality (log-rank P = 0.0001).

Study Design

Type

Cohort (n=1,421)

Multicenter

Structured PICO

Does the logistic EuroSCORE accurately predict operative mortality in high-risk patients undergoing conventional aortic valve replacement for severe aortic stenosis?

Population

1,421 consecutive patients with severe aortic stenosis who underwent conventional aortic valve replacement (AVR) between 1995 and 2005 at a single institution, including 237 patients (16.7%) with a logistic EuroSCORE > 20.

Intervention

Risk stratification using the logistic EuroSCORE

Comparator

Observed operative mortality

Outcome

Accuracy of the prognostic risk prediction provided by logistic EuroSCORE (comparing observed and expected operative mortality)hard clinical

Main Result

Effect estimate: O/E ratio 0.29 (95% CI 0.15-0.52)

Absolute Event Rate: 11.4% vs 38.7%

p-value: p=<0.05

The logistic EuroSCORE significantly overestimates operative mortality in high-risk patients undergoing aortic valve replacement, suggesting it should not be used in isolation to withhold surgery or select alternative therapies.

Limitations

Data reflect the experience of a single center which may limit the study's generalizability
Lack of data on the larger population of patients with severe aortic stenosis who are never presented to the multidisciplinary peer review conference

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

EuroSCORE overestimates mortality after high-risk AVR; leaves open its role in treatment selection pending validation.

Cite This Study

Kalavrouziotis et al. (2009) conducted a cohort in severe aortic stenosis (n=1,421). Conventional aortic valve replacement (AVR) vs. Predicted mortality by logistic EuroSCORE was evaluated on Operative mortality in patients with logistic EuroSCORE > 20 (O/E ratio 0.29, 95% CI 0.15-0.52, p=<0.05). Actual operative mortality in high-risk patients with severe aortic stenosis undergoing aortic valve replacement was significantly lower than predicted by the logistic EuroSCORE (11.4% vs. 38.7%, O/E ratio 0.29).

synapsesocial.com/papers/6a1ae41249c6765e38860927 https://doi.org/10.1186/1749-8090-4-32

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The European System for Cardiac Operative Risk Evaluation (EuroSCORE) is not appropriate for withholding surgery in high-risk patients with aortic stenosis: a retrospective cohort study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

The European System for Cardiac Operative Risk Evaluation (EuroSCORE) is not appropriate for withholding surgery in high-risk patients with aortic stenosis: a retrospective cohort study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

Also Consider