Utility of the Euroscore II in Predicting Long-Term Outcomes in a Contemporary Australian Cohort With Complex...

Area of Science:

• Cardiovascular Medicine
• Health Services Research

Background:

• The EuroSCORE II is established for cardiac surgery mortality risk. Its role in broader coronary artery disease (CAD) management, including percutaneous coronary intervention (PCI) and medical therapy, is less clear.
• Multidisciplinary Heart Team discussions are crucial for complex CAD patient management.

Purpose of the Study:

• To evaluate the prognostic utility of EuroSCORE II in predicting long-term major adverse cardiovascular events (MACE) in patients with complex CAD managed by a Heart Team.
• To assess if a EuroSCORE II threshold of ≥2% can identify higher-risk patients across different treatment strategies (CABG, PCI, medical therapy).

Main Methods:

• Retrospective cohort study of 546 patients with complex CAD from a tertiary Australian center (2019-2024).
• EuroSCORE II was calculated for all patients; a threshold of ≥2% defined higher risk.
• Primary endpoint was a composite of MACE (myocardial infarction, stroke, all-cause mortality) assessed via Cox models, ROC analysis, and Kaplan-Meier estimates over a median 3.2-year follow-up.

Main Results:

• A median EuroSCORE II of 1.19% was observed; 65.2% underwent CABG, 12.6% PCI, and 19.6% medical therapy.
• Patients with EuroSCORE II ≥2% had a significantly higher risk of MACE (HR 2.58, p < 0.001).
• Overall predictive accuracy for MACE was limited (AUC 0.66), with varying AUCs for different treatment groups (CABG 0.59, PCI 0.72, medical therapy 0.66).

Conclusions:

• In a contemporary Heart Team setting, EuroSCORE II ≥2% independently predicts long-term MACE and mortality in complex CAD patients.
• EuroSCORE II demonstrates pragmatic utility as an adjunct for risk stratification and treatment planning beyond its conventional surgical application.
• Further validation is needed to refine its application across diverse CAD management strategies.