The European Risk Factor Scoring System for Cardiovascular Surgery (EuroSCORE)
In 1989, Parsonnet et al. established a risk factor scoring system for cardiovascular surgery, providing for the first time a quantifiable and more objective scale. Since then a variety of risk factor scoring methods for cardiac surgery have emerged. For example, the North American risk-stratification, the British national score, and the Canadian Ontario risk score. The most well-known one is the European system for cardiac operative risk evaluation (EuroSCORE), which was established in 1995.
Establishment of EuroSCORE
The original EuroSCORE panel consisted of cardiac medical surgeons and epidemiologists. They selected 68 preoperative risk factors and 29 operative-related risk factors for analysis in 20,014 adult cardiovascular surgery patients from 132 surgical centers in 8 European countries during December, after a preliminary study and with reference to the North American risk factor model. The final screening ~risk factors from 97 risk factors was then performed on the included 1995 9 out of 17 high risk factors associated with mortality for European patients namely.
1. patient-related factors.
Age ≥ 60 years (1 point / 5 years)
Female (1 point)
Chronic lung disease (1 point)
Extracardiac arterial system disease (2 points)
Neurological dysfunction (2 points)
History of previous cardiac surgery (3 points)
Plasma creatinine concentration >200m mol/l (2 points)
Active endocarditis (3 points)
Preoperative critical state (3 points).
2. Cardiac-related factors.
Unstable angina requiring pharmacological intervention (3 points), the
left ventricular insufficiency (LVEF 30-50%: 1 point, LVEF <30%: 3 points)
history of previous heart attack within 90 days (2 points).
Pulmonary artery systolic pressure >60 mmHg (2 points).
3. Surgery-related factors.
Emergency surgery (2 points).
CABG combined with other cardiac surgery (2 points), the
thoracic aortic surgery (3 points), the
post-infarction ventricular septal perforation (4 points).
Application of EuroSCORE
EuroSCORE is relatively simple and accurate compared to previous scoring systems, so it has gained rapid popularity in recent years. Pinna et al. found a negative correlation between hospitalization costs and EuroSCORE, with a 3.5% increase in medical costs for every 1-point increase in the score.
Conclusion
The EuroSCORE is one of the most popular preoperative cardiac risk factor scoring methods available due to its clear advantages in accuracy, completeness and practicality. The idea of this score also inspires us whether we can proceed to establish a Chinese cardiac surgery scoring system that reflects the characteristics of the national population.