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Risk Factors for Early Mortality after Valve Surgery in Europe in the 1990s:
Lessons from the EuroSCORE Pilot Program
The study aim was to explore the demographics and risk factors of valve surgery in Europe in the 1990s. Using the EuroSCORE database, information on 98 variables for risk factors, procedures and outcome were collected from 5,672 patients undergoing valve surgery under cardiopulmonary bypass in 128 European centers. Bivariate, then logistic regression analyses were carried out to identify risk factors for early mortality. The predictive value of EuroSCORE was analyzed using the Hosmer-Lemershow test and by computing the area under the receiver operating characteristic (ROC) curve. Aortic valve stenosis was the most common diagnosis (47.6%); mitral valve surgery accounted for 42% of procedures. Coronary surgery was performed concomitantly in 21% of the cases. Hospital mortality was 6.1%. Predictive factors for early mortality were: age (p = 0.0001), preoperative serum creatinine >200 µmol/l (p = 0.014), previous heart surgery (p = 0.0001), poor left ventricular function (p = 0.008), chronic congestive heart failure (p = 0.0001), pulmonary hypertension (p = 0.0001), active acute endocarditis (p = 0.0001), emergency procedure (p = 0.05), critical preoperative status (p = 0.0001), tricuspid surgery (p = 0.015), aortic and mitral surgery (p = 0.002), combined thoracic surgery (p = 0.0001), and combined coronary surgery (p = 0.0001). The predictive value of EuroSCORE for mortality is good (area under the ROC curve = 0.75). The ‘valve ’ subset of the EuroSCORE database provides an instant picture of European valve surgery in the 1990s that can be used either for individual assessment, or for country- or institution-based epidemiological studies of risk factors and practices. |
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