Coronary surgery in Europe: comparison of the national subsets of the European System for Cardiac Operative Risk Evaluation database

Objective: To compare the national samples of patients who underwent isolat ed coronary artery bypass grafting (CABG) during the European System for Ca rdiac Operative Risk Evaluation (EuroSCORE) trial in order to evaluate nati onal differences in epidemiology, patient risk profile and surgical methods . Methods: From September to November 1995, 11 731 patients had CABG in the six largest contributing nations to the EuroSCORE project: Germany, UK, Sp ain, Finland, France and Italy. The Chi-square and Kruskal-Wallis tests wer e applied to obtain an international comparison of patient general status, including pre-operative risk factors, cardiac status, critical preoperative states, rare conditions, urgency of surgery, angina status, coronary lesio ns, procedures and EuroSCORE risk assessment. Results: Large national sampl es (from 984 patients in Finland to 3138 in Germany) identified significant differences in epidemiology, risk profile and surgical practice. Regarding epidemiology, CABG accounted for 62.8% of adult cardiac surgery, with a ra nge of 46.2 in Spain to 77.7% in Finland (P < 0.001). The mean age was 62.9 years (61.4 in Britain to 64.4 in France, P < 0.001). The mean body mass i ndex was 26.8 (26 in France to 27.5 in Finland, P < 0.001). With regard to risk profile, diabetes was present in 20.3% of patients (11.8% in Britain t o 27.7% in Spain, P < 0.001). Chronic renal failure was present in 8.3% (6. 8% in Germany to 10.6% in Spain, P < 0.001). Chronic airway disease affecte d 3.8% (1.9% in Italy to 5.1% in Germany, P < 0.001). The mean ejection fra ction was 0.56 (0.48 in Britain to 0.58 in Finland, P < 0.001). The mean pr edicted mortality (according to EuroSCORE) was 3.3% (2.8% in Finland to 3.6 % in France, P < 0.001). The prevalence of chronic congestive heart failure , unstable angina and recent myocardial infarction also showed statisticall y significant differences. No differences were found for some critical preo perative states (such as immediate preoperative cardiac massage and preoper ative intubation), or for surgery for catheter laboratory complication. Reg arding surgical practice, major differences were noted in preoperative intr a-aortic balloon use (mean 1%, Finland 0%, Spain 2.3%, P < 0.001), the numb er of mammary artery conduits used (mean 0.9, Spain 0.7, France 1.1, P = 0. 0001) and the number of distal anastomoses (mean 3, France 2.7, Finland 3.8 , P = 0.001). Conclusion: There are Important epidemiological differences i n the national cohorts of CABG patients in the EuroSCORE database. Any inte rnational comparison of European surgical results must therefore take into account the risk profile of patients by using a compatible risk stratificat ion system. (C) 2000 Elsevier Science B.V. All rights reserved.