Performance of the European System for Cardiac Operative Risk Evaluation II: A meta-analysis of 22 studies involving 145,592 cardiac surgery procedures
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Objectives A systematic review of the European System for Cardiac Operative Risk Evaluation (euroSCORE) II performance for prediction of operative mortality after cardiac surgery has not been performed. We conducted a meta-analysis of studies based on the predictive accuracy of the euroSCORE II.Methods We searched the Embase and PubMed databases for all English-only articles reporting performance characteristics of the euroSCORE II. The area under the receiver operating characteristic curve, the observed/expected mortality ratio, and observed-expected mortality difference with their 95% confidence intervals were analyzed.Results Twenty-two articles were selected, including 145,592 procedures. Operative mortality occurred in 4293 (2.95%), whereas the expected events according to euroSCORE II were 4802 (3.30%). Meta-analysis of these studies provided an area under the receiver operating characteristic curve of 0.792 (95% confidence interval, 0.773-0.811), an estimated observed/expected ratio of 1.019 (95% confidence interval, 0.899-1.139), and observed-expected difference of 0.125 (95% confidence interval, -0.269 to 0.519). Statistical heterogeneity was detected among retrospective studies including less recent procedures. Subgroups analysis confirmed the robustness of combined estimates for isolated valve procedures and those combined with revascularization surgery. A significant overestimation of the euroSCORE II with an observed/expected ratio of 0.829 (95% confidence interval, 0.677-0.982) was observed in isolated coronary artery bypass grafting and a slight underestimation of predictions in high-risk patients (observed/expected ratio 1.253 and observed-expected difference 1.859).Conclusions Despite the heterogeneity, the results from this meta-analysis show a good overall performance of the euroSCORE II in terms of discrimination and accuracy of model predictions for operative mortality. Validation of the euroSCORE II in prospective populations needs to be further studied for a continuous improvement of patients' risk stratification before cardiac surgery.
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A recent review identified 23 validations of EuroSCORE II in patients undergoing cardiac surgery.
“In a recent review,17 23 validations of EuroSCORE II were identified in which its predictive performance was examined in patients undergoing cardiac surgery.”
From A framework for meta-analysis of prediction model studies with binary and time-to-event outcomes (2019) · cites this paper as [17]
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- Authors
- Guida, P., Mastro, F., Scrascia, G., Whitlock, R., & Paparella, D.
- Affiliations
- University of Bari Aldo Moro (IT)
- Population Health Research Institute (CA)
- Corresponding author
- Paparella, Domenico
- Venue
- The Journal of Thoracic and Cardiovascular Surgery
- Publisher
- Elsevier BV
- Published
- 2014-12
- Volume
- 148
- Issue
- 6
- Pages
- 3049-3057.e1
- ISSN
- 0022-5223 (ISSN-L)
- OpenAlex
- W2115362859
- Cited by
- 126
- References
- 42
- Citations by year
- 2026: 9 · 2025: 9 · 2024: 8 · 2023: 13 · 2022: 8 · 2021: 10 · 2020: 12 · 2019: 15 · 2018: 8 · 2017: 14 · 2016: 9 · 2015: 11
- FWCI
- 1.83
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutional Research Information System (University of Bari Aldo Moro) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Keywords
- EuroSCORE II, cardiac surgery, postoperative mortality, risk prediction, risk stratification, mortality prediction accuracy, coronary artery bypass grafting, valve surgery, revascularization, model validation
- MeSH terms
- Decision Support Techniques, Cardiac Surgical Procedures, Humans, Predictive Value of Tests, Risk Factors, ROC Curve, Treatment Outcome, Hospital Mortality, Risk Assessment, Area Under Curve
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