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EuroSCORE as predictor of in-hospital mortality after percutaneous coronary intervention
E Romagnoli1, F Burzotta, C Trani
1Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy. enromagnoli@gmail.com
Insights
The European System for Cardiac Operative Risk Evaluation (EuroSCORE) effectively predicts in-hospital mortality in patients undergoing percutaneous coronary intervention (PCI). This validated risk model aids in decision-making for coronary artery disease revascularization strategies.
Area of Science:
- Cardiology
- Medical Risk Assessment
- Interventional Cardiology
Background:
- No standardized risk stratification system exists for coronary artery disease (CAD) revascularization.
- Accurate prediction of mortality risk is crucial for treatment decisions.
Purpose of the Study:
- To evaluate the validity of the European System for Cardiac Operative Risk Evaluation (EuroSCORE) for predicting in-hospital mortality after percutaneous coronary intervention (PCI).
Main Methods:
- Prospective assessment of EuroSCORE in 1173 consecutive patients undergoing PCI.
- Utilized receiver-operating characteristic (ROC) curve analysis to determine model performance and accuracy.
- Multivariable logistic regression analysis identified independent predictors of mortality.
Main Results:
- EuroSCORE demonstrated a consistent relationship between risk rank and in-hospital mortality incidence across patient subgroups.
- EuroSCORE was an independent predictor of in-hospital mortality (p = 0.002).
- The area under the ROC curve was 0.91, indicating good discriminative ability for predicting mortality risk.
Conclusions:
- The EuroSCORE risk model, validated for open-heart surgery, is also effective for predicting early mortality in PCI settings.
- Integrating EuroSCORE assessment can enhance revascularization strategy decision-making for patients with CAD.
Objective:
To date, no common risk stratification system is available to predict the risk of surgical or percutaneous myocardial revascularisation in patients with coronary artery disease (CAD). Thus, we sought to assess the European System for Cardiac Operative Risk Evaluation (EuroSCORE) validity to predict in-hospital mortality after percutaneous coronary intervention (PCI).
Design, Setting And Participants:
EuroSCORE was prospectively and systematically assessed in 1173 consecutive patients undergoing PCI in a high-volume single centre between April 2005 and October 2006.
Main Outcome Measure:
The receiver-operating characteristics (ROC) curve was used to describe performance and accuracy of the EuroSCORE risk model for the prediction of in-hospital mortality after PCI.
Results:
The EuroSCORE model demonstrated an overall relation between EuroSCORE rank and the incidence of in-hospital mortality, showing consistency in predicting patient risk across many subgroups and levels of global risk. At multivariable logistic regression analysis the EuroSCORE value was an independent in-hospital mortality predictor (p = 0.002) together with left main disease (p = 0.005), procedural urgency (p = 0.001), ACC/AHA C type lesion (p = 0.02) and PCI failure (p = 0.01). The area under the ROC curve for the EuroSCORE system was 0.91 (95% CI 0.86 to 0.97), indicating a good ability of the model to discriminate patients at risk of dying during the index hospitalisation.
Conclusion:
The EuroSCORE risk model, already extensively validated for the prediction of early mortality following open-heart surgery, can also be efficiently utilised in the setting of PCI. The introduction of the EuroSCORE assessment in patients with documented CAD may help to improve the revascularisation strategy decision-making process.
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