Aplicação do EuroSCORE na cirurgia de revascularização miocárdica em hospitais públicos do Rio de Janeiro

Abstract

Background: Risk stratification models are used to assess the risk of death in surgery.Objective: To conduct a critical analysis of the EuroSCORE logistic model (ES) application in 2,692 patients undergoing Coronary Artery Bypass Grafting (CABG) in four public hospitals in the Rio de Janeiro Municipality, from 1999 through to December 2003.Methods: Random samples of 150 medical records for surviving and deceased patients were selected at four public hospitals in the City of Rio de Janeiro. The ES was applied, using the logistical model. The observed lethality rate and that forecast by the model were compared. The measurement of the discriminatory power was estimated by the area under the ROC curve.Results: 546 of the 600 selected medical records were located. A significant difference was noted between the prevalence rates for the risk factors in the Brazilian and European populations. The forecast lethality rate was 3.62% (CI-95%: 3.47-3.78) while the estimated observed rate was 12.22% (CI-95%-10.99-13.46). In all risk ranges, the predicted lethality rate is under-estimated, with notable differences between the predicted and observed rates. The area under the ROC curve was estimated at 0.62. Conclusion: The differences in the prevalence rates for the risk factors constituting the ES, associated with its low power of discrimination, hamper any recommendation of the use of this model in Brazil, without the necessary adjustments.Descriptors: Risk Factors; Coronary Artery Bypass; Coronary Artery Disease. 210CARVALHO, MRM ET AL -Application of the EuroSCORE in coronary artery bypass surgery in public hospitals in Rio de Janeiro, Brazil Rev Bras Cir Cardiovasc 2010; 25(2): 209-217

Letalidade e complicações da cirurgia de revascularização miocárdica no Rio de Janeiro, de 1999 a 2003

“…In a study conducted with 650 patients who had undergone CABG from July 2002 to January 2003 in the state of Rio de Janeiro, severe ventricular dysfunction was considered the second factor in order of association with mortality 19 . In the study on the association of preoperative factors and deaths following CABG undertaken with the same database of our study, a higher number of deaths was observed among those patients with severe left ventricular dysfunction 20 . Of the 23 preoperative factors analyzed, only 7 showed a significant association with the postoperative course of the patients: age, hypertension, current smoking status, dyslipidemia, stroke, ECT lesion higher than 50% combined with one or more lesions in other coronary systems, and the hospital 20 .…”

EuroSCORE e mortalidade em cirurgia de revascularização miocárdica no Pronto Socorro Cardiológico de Pernambuco

“…On the other hand, Oliveira et al [20] recently published a study involving public hospitals and showed an in-hospital mortality rate ranging from 7% to 14.3%. Another recent study [18] involving 600 patients undergoing CABG at public hospitals has shown a mortality rate in the in-hospital phase of 12.2%. Apparently, there is some influence of the institutional factor (public vs private), in which it has been observed that the in-hospital mortality rate at public institutions is higher than the in-hospital mortality rate at private institutions.…”

“…However, there are doubts about the fact that this study [17] is representative of cardiac surgeries performed in public institutions in the State of Pernambuco, once it was conducted in a private institution. Recently, Carvalho et al [18] advised against the use of the EuroSCORE as a tool for assessment of operative risk in patients who were to undergo CABG in public hospitals in Rio de Janeiro, in view of the low discriminatory power observed in that study. Nevertheless, the EuroSCORE has not been tested at a public institution in our region.…”

Proposição de um escore de risco cirúrgico em pacientes submetidos à cirurgia de revascularização miocárdica

“…To test the model calibration, the observed mortality was compared with the predicted one in all patients in each of the five interval classification of the score, obtaining a expected/ observed correlation coefficient of 0.99, P <0.001 and H-L test equal to 0.617 (Tables 3-5 and Figures 1 and 2). 2595 (92) 214 (8) 272 (10) 2537 (90) 98 (4) (25) 53 (19) 227 (9) 23 (23) 257 (9) 27 (15) 253 (9) 16 (16) 264 (10) 92 (11) 188 (10) 124 (29) 156 (7) 109 (20) 171 (8) 196 (10) 84 (10) 118 (54) 162 (6) 34 (11) 246 (10) 142 (13) 138 (8) 63 (21) 217 (9) 106 (9) 174 (11) 65 (11) 215 (10) Non-deaths n = 2529 (%) …”

“…In Brazil, there is already a score developed to predict the risk for patients undergoing CABG [14]. The profile of patients undergoing CABG in Brazil differs significantly from those in Europe, as demonstrated in a study [15], which compared the risk factors of patients included in the EuroSCORE, with risk factors more prevalent in patients undergoing CABG in four hospitals. In this study, there was a greater proportion of young patients, women, hypertensive and diabetic people.…”