Key result
EuroSCORE II shows good operative mortality discrimination with ~0.83 AUC but underestimates aortic dissection risk.
Why the study?
The predictive performance of EuroSCORE II may have evolved over the last decade because of an ageing population, increasing comorbidity burden, and advances in perioperative management, warranting evaluation in a contemporary nationwide cohort.
Does EuroSCORE II accurately predict operative mortality (in-hospital or 30-day mortality) in contemporary adult patients undergoing cardiac surgery?
Observational (n=108,412)
Yes
Does EuroSCORE II accurately predict operative mortality (in-hospital or 30-day mortality) in contemporary adult patients undergoing cardiac surgery?
In a contemporary nationwide French cohort of 108,412 cardiac surgery patients, EuroSCORE II maintained good overall discriminative ability (AUC 0.83) for operative mortality, though it overestimated risk in low-risk procedures like isolated CABG and underestimated risk in high-risk settings like acute aortic dissection.
Answers are grounded in this paper and cite their sources.
EuroSCORE II remains useful for operative risk prediction in cardiac surgery; leaves open the need for recalibration in acute aortic dissection.
Objective The predictive performance of EuroSCORE II may have evolved over the last decade owing to major changes in cardiac surgery practice, including an ageing population, increasing comorbidity burden, and advances in perioperative management. We aimed to evaluate the contemporary performance of EuroSCORE II in a large nationwide French cohort. Methods We conducted a retrospective analysis of consecutive adult patients undergoing cardiac surgery between 2020 and 2024 in centers participating in the French EPICARD registry (French Society of Cardiothoracic and Vascular Surgery, Federation des Specialites Medicales, France). Patients undergoing heart transplantation, durable mechanical circulatory support implantation, cardiac tumor surgery, or with missing EuroSCORE II data were excluded. The primary endpoint was operative mortality, defined as in-hospital or 30-day mortality, identified through linkage with the French national mortality database (INSEE). Discrimination was assessed using the area under the receiver operating characteristic curve (AUC), while calibration was evaluated using the Hosmer–Lemeshow test and calibration plots. Results A total of 108,412 patients were included. Median EuroSCORE II was 1.7% [IQR 1.0–3.4], and overall operative mortality was 3.3% (n = 3,572). EuroSCORE II demonstrated acceptable discriminative performance (AUC 0.83, 95% CI 0.82–0.84). Calibration varied across surgical subgroups, with slight overestimation in low-risk patients and isolated CABG, and underestimation in high-risk settings, particularly acute aortic dissection and combined CABG-aortic procedures. Conclusions EuroSCORE II remains a valuable risk stratification tool in contemporary cardiac surgery but shows calibration limitations in specific high-risk populations, supporting the need for periodic recalibration and updated risk models.
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Piccoli et al. (2026) conducted an observational in Adult patients undergoing cardiac surgery (n=108,412). EuroSCORE II predicted operative mortality vs. Observed in-hospital or 30-day operative mortality was evaluated on Operative mortality (in-hospital or 30-day mortality) (AUC 0.83, 95% CI 0.82-0.84, p=<0.001). EuroSCORE II demonstrated good discrimination for operative mortality, though it underestimated risk in acute aortic dissection.
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