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The EuroSCORE is the most widely used tool for predicting short- and long-term mortality in patients undergoing major elective cardiac surgery. Although the overall predictive value of the EuroSCORE has been validated, its use has been criticized because it fails to properly weigh the risk of in-hospital mortality. The purpose of this study was to determine whether risk stratification of postoperative mortality could be improved by analyzing the endpoint in more detail. A retrospective database analysis. University hospital. From January 1, 1999, to December 31, 2000, 688 consecutive patients undergoing elective cardiac surgery. Our dataset included 493 (72%) patients who received the original EuroSCORE and 205 (28%) who received a modified EuroSCORE. The patient characteristics and risk factors were comparable between the two study groups. A stratified analysis of in-hospital and 30-day mortality was performed. At a constant mortality rate of 10%, risk stratification with the original EuroSCORE identified 53.4% of patients as low risk, 15.2% as intermediate risk, and 31.4% as high risk. With the refined EuroSCORE, 78% of patients were classified as low risk, 8% as intermediate risk, and 14% as high risk. Four risk factors were the only significant predictors of in-hospital mortality in the refined EuroSCORE. The original EuroSCORE performed poorly when studied with a refined endpoint. In more complex analyses, it is able to identify some patients at high risk of mortality, whereas in other analyses it is unable to differentiate between patients with intermediate risk of mortality. Therefore, our study supports the use of the refined EuroSCORE, as this strategy is able to predict some but not all cases of in-hospital mortality.Q:

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