The European system for cardiac operative risk evaluation (EuroSCORE) is a commonly used risk score for operative mortality following cardiac surgery. We aimed to conduct a systematic review of the performance of the additive and logistic EuroSCORE. A literature search resulted in 67 articles. Studies applying the EuroSCORE on patients undergoing cardiac surgery and which reported early mortality were included. Weighted meta-regression showed that the EuroSCORE overestimated mortality. However, this performance depended on the risk profile of patients: in high-risk patients, the additive model actually underestimated mortality. Discriminative performance was good. Given the poor predictive performance, the EuroSCORE may not be suitable as a tool for patient selection nor for benchmarking.