EuroSCORE II (Cardiac Surgery Risk)
EuroSCORE II predicts in-hospital mortality after cardiac surgery using 18 patient, cardiac, and operation-related variables in a logistic regression model. It replaced the additive and logistic EuroSCORE I and is the standard cardiac surgical risk tool in Europe.
inputs
✓ when to use
Use for all patients being evaluated for cardiac surgery (CABG, valve surgery, combined procedures, aortic surgery). EuroSCORE II is essential for heart team discussions comparing surgical vs transcatheter approaches (e.g., TAVI vs SAVR in aortic stenosis). Informs consent discussions and outcome benchmarking.
✗ when not to use
EuroSCORE II was derived from a 2010 European cardiac surgery cohort — it may not perfectly calibrate to 2026 outcomes or non-European populations. It does not predict morbidity (stroke, renal failure, prolonged ventilation) — only mortality. For US practice, the STS PROM (Society of Thoracic Surgeons Predicted Risk of Mortality) is the preferred alternative. Not validated for percutaneous coronary intervention (PCI).
clinical pearls
- The key clinical application: in aortic stenosis, EuroSCORE II (alongside STS PROM and frailty assessment) determines whether TAVI or surgical AVR is recommended. The ESC/EACTS 2021 guidelines use these scores in the heart team algorithm.
- EuroSCORE II variables include: age, sex, renal function, extracardiac arteriopathy, poor mobility, previous cardiac surgery, chronic lung disease, active endocarditis, critical preoperative state, diabetes on insulin, NYHA class, CCS class 4 angina, LVEF, recent MI, pulmonary hypertension, urgency of operation, weight of procedure, and surgery on thoracic aorta.
- EuroSCORE I (both additive and logistic) significantly overestimates mortality in contemporary practice. Always use EuroSCORE II. If a colleague quotes a EuroSCORE of 20%, check whether it is version I or II.
- STS PROM is the US standard (sts.org). EuroSCORE II is the European standard (euroscore.org). They use different models, variables, and endpoints — they are not interchangeable. Heart teams should use the tool appropriate to their regional guidelines.
- Frailty is not directly captured by EuroSCORE II. Adding a frailty assessment (e.g., CFS, gait speed) to the heart team discussion improves decision-making beyond the score alone.