Avaliação do EuroSCORE como preditor de mortalidade em cirurgia de revascularização miocárdica no Instituto do Coração de Pernambuco

Abstract

Objective: To assess the applicability of the European Risk Score System in Cardiac Operations (EuroSCORE) in patients undergoing myocardial revascularization at the Heart Institute of Pernambuco.Method: From 2003 to 2004, 759 patients underwent myocardial revascularization. For the study, seven were excluded due to the lack of information on one aspect or another involved in obtaining the EuroSCORE. In order to assess the applicability of the EuroSCORE, an adjustment was made using a logistic regression model of operative mortality (response variable) on the EuroSCORE (explanatory variable). The calibration of the model was measured by comparing the morbidity observed with that expected, using the Hosmer-Lemeshow Test of Goodness of Fit. The accuracy of the model was evaluated by means of Statistics-c.Results: The accuracy of the model, estimated at 69.9%, and the calibration (Hosmer-Lemeshow test, p=0.663) were satisfactory. The total predicted mortality was practically identical to the observed -1.7%. The low-risk group (EuroSCORE: 0-2) comprised 231 patients and had two (0.87%) deaths within this group. The medium-risk group (EuroSCORE: 3-5) comprised 268 patients and one (0.37%) death occurred. The high-risk group (EuroSCORE: =6) comprised 253 patients and ten (3.95%) deaths occurred. The discrepancies between the percentages of deaths observed in these groups and those predicted by the model were not statistically significant on the basis of the result of the chisquare test (p=0.624).Conclusion: The EuroSCORE, a simple and objective index, proved to be a satisfactory predictor of operative mortality in patients submitted to myocardial revascularization in the Heart Institute of Pernambuco.

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

“…Moraes et al [17] performed a validation study in 752 patients undergoing coronary artery bypass grafting (CABG) at a Brazilian institution in the State of Pernambuco, demonstrating that the EuroSCORE obtained good prediction of mortality (similar to that expected). 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.…”

“…An important aspect is the fact that we are studying a population undergoing operations at a public institution. Moraes et al [17] performed a study involving 752 patients undergoing CABG in private institution, showing a mortality rate of 1.7%. 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%.…”

“…For this reason, any risk scoring system can reliably be used only when its validity was tested in the local patient population [16]. Moraes et al [17] performed a validation study in 752 patients undergoing coronary artery bypass grafting (CABG) at a Brazilian institution in the State of Pernambuco, demonstrating that the EuroSCORE obtained good prediction of mortality (similar to that expected). 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.…”

Controle de qualidade em cirurgia cardiovascular: um paradigma a ser atingido

“…The latter is particularly important when dealing with critically-ill patients, since the data attained by logistic regression of the independent variables are closer of the reality observed. Data from EuroScore surgical forecast were also validated for Brazilian patients [12].…”

Fatores de risco para mortalidade em octogenários submetidos a cirurgia de revascularização miocárdica

“…This group of patients, due to the aging process itself, has comorbidities that increase the operative risk 5,6 . One of the most widely used risk scores today, the EuroSCORE 7,8 , applies a significant weight to age over 60 years in the final calculation of mortality risk. However, it seems reasonable to consider all the elderly patients as a homogeneous group, and age, by itself, as a determinant of greater risk 9,10 .…”