Is EuroSCORE applicable to Indian patients undergoing cardiac surgery?

Abstract

Indian patients undergoing cardiac surgery have different demographics, clinical profile as well as risk profile, compared to the western population. The purpose of this study was to validate the European System for Cardiac Operative Risk Evaluation (EuroSCORE) risk stratification model in Indian patients undergoing cardiac surgery in a single cardiac center. Data from 1000 consecutive adult patients undergoing cardiac surgery (coronary artery bypass grafting or valve surgery) were prospectively collected as per the EuroSCORE model. The model's validity was assessed on the basis of its calibration power (Hosmer-Lemeshow test) and discriminatory power [area under receiver operating characteristic curve]. The patients were divided into three risk groups on the basis of their EuroSCORE. The Hosmer-Lemeshow test revealed a good calibration power (P = 0.73) and the area under the ROC curve was 0.8278, suggesting a good discriminative power. The predicted mortality was similar to observed mortality in low- and moderate-risk patients but the observed mortality in high-risk patients (15.6%) was double that of predicted mortality (7.5%). The risk factors prevalent in European population were not observed in Indian population. EuroSCORE accurately predicts mortality in low and moderate-risk Indian patients undergoing cardiac surgery but is less predictive for high-risk Indian patients. Updating and improvisation of EuroSCORE by incorporation of risk factors associated with rheumatic valvular heart disease which is more prevalent in India, may enable it to accurately predict mortality in high-risk patients also.

Impact of type of procedure and surgeon on EuroSCORE operative risk validation

“…The EuroSCORE overestimated mortality in patients at very high risk and there was still a tendency to overestimate mortality in low-risk patients. These findings are consistent with the most recent case series from developed countries [ 14 ] , unlike other series [ 6 - 8 ] have shown exactly the opposite.…”

“…External validation of the EuroSCORE in various populations around the world occurred initially with good results [ 3 - 5 ] . However, most authors have recently demonstrated that the logistic EuroSCORE overestimates the expected mortality, although some developing countries show the opposite [ 6 - 8 ] . The reasons for this discrepancy in model validation involve multiple factors: different characteristics of the exposed population, the hospitals and their treatment protocols, training teams and socioeconomic [ 9 ] differences.…”

The application of European system for cardiac operative risk evaluation II (EuroSCORE II) and Society of Thoracic Surgeons (STS) risk-score for risk stratification in Indian patients undergoing cardiac surgery

“…This study (n = 1000) revealed good calibration and discrimination power of the score. [11] The EuroSCORE accurately predicted mortality in low and moderate risk Indian patients but under-estimated in high-risk Indian patients. In contrast, in the present study, the risk was over estimated in high-risk patients by both the scoring systems.…”

Effects of remote ischemic preconditioning in high-risk patients undergoing cardiac surgery (Remote IMPACT): a randomized controlled trial

“…18 Previous research showed that, among patients undergoing valvular surgery, the risk of death for patients in India and China with EuroSCORE values of at least 4 was similar to that for North American patients with EuroSCORE values of at least 6. 19,20 Therefore, in the current study, eligibility was extended to patients undergoing valvular surgery in Indian and Chinese centres who had a EuroSCORE value of 4 or above. Patients were excluded if an intra-aortic balloon pump was used before surgery.…”