Mortality prediction in Indian cardiac surgery patients: Validation of European System for Cardiac Operative Risk Evaluation II

Abstract

Background and Aims:Risk Stratification has an important place in cardiac surgery to identify high-risk cases and optimally allocate resources. Hence various risk scoring systems have been tried to predict mortality. The aim of the present study was to validate the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) in Indian cardiac surgical patients.Methods:After obtaining ethics committee clearance, data on EuroSCORE II variables were collected for all patients >18 years undergoing on-pump coronary artery bypass graft (CABG), valve surgery and mixed (CABG + valve) procedures between January 2011 and December 2012. Mortality prediction was done using the online calculator from the site www.euroscore.org. The calibration of the EuroSCORE II model was analysed using the Hosmer–Lemeshow test and discrimination was analysed by plotting receiver operating characteristic curves (ROC) and calculating area under the curve (AUC). The analysis was done in the total sample, CABG, valve surgery and in mixed procedures.Results:The overall observed mortality was 5.7% in the total sample, 6.6% in CABG, 4.2% in valve surgeries and 10.2% in mixed procedures whereas the predicted mortality was 2.9%, 3.1%, 2.4%, 5.1% in total sample, CABG, valve surgery and mixed procedure, respectively. The significance (P value) of Hosmer–Lemeshow test was 0.292, 0.45, 0.56 and 1 for the total sample, CABG, valve surgery and mixed procedure, respectively, indicating good calibration. The AUC of ROC was 0.76, 0.70, 0.83 and 0.78 for total sample, CABG, valve surgery and mixed procedure, respectively.Conclusion:Mortality of the sample was under-predicted by EuroSCORE II. Calibration of the EuroSCORE II model was good for total sample as well as for all surgical subcategories. Discrimination was good in the total sample and in the mixed procedure population, acceptable in CABG patients and excellent in valve surgeries.

External validation of the European System for Cardiac Operative Risk Evaluation II in a Tunisian population

“…To obtain results comparable to those of our study, we can consult the Asian series like that of Atashi et al, that of Kar et al, or that of Pillai et al…”

“…Only a few series offer results comparable to ours, such as that of Stavridis et al (2.23) or that of Kar et al (1.94) for any type of cardiac surgery included, or that of Laurent et al for aortic valve replacement or that of Kalender et al (6.77) for emergency coronary surgery or that of De Oliveira et al and that of Taamallah et al for surgery of infectious endocarditis.…”

“…These differences may be related to longer life expectancy and a lower incidence of rheumatic heart disease (more common among women in our country) than in European countries. To obtain results comparable to those of our study, we can consult the Asian series like that of Atashi et al, 12 that of Kar et al, 13 or that of Pillai et al 14 Since the population of EuroSCORE II is 9 years older than our population, there should be more comorbidities, but paradoxically, we found that diabetes on insulin was more common in our population while chronic lung disease was more common in the population of the original study.…”

A Novel Method of Immunomodulation of Endothelial cells Using Streptococcus Pyogenes and its Lysate

“…The incidence in our center and other centers as well show a low association of coronary artery disease with rheumatic valvular heart diseases, irrespective of age and metabolic characteristics. 2,3 The incidence of mixed procedure i.e., combined valve surgeries and bypass surgeries, is <5%. And further analysis looking for rheumatic valvular etiology in these combined procedures would be much lesser, even in high volume centers like TUMS.…”

“…In patients with rheumatic heart diseases, the incidence of coronary artery diseases is low. [2][3][4][5] This was observed in some studies in India and neighboring countries. Hence, in this study the streptococcus pyogenes infections were used to study the immune modulatory potentials in the endothelial cells.…”