Outcome Evaluation of Coronary Artery Bypass Grafting Surgery Applying the EuroSCORE in a Caribbean Developing Country
DOI:
https://doi.org/10.1532/HSF98.20101026Abstract
Background: The risk-adjusted outcome of coronary artery bypass grafting (CABG) in Trinidad and Tobago was evaluated by applying the EuroSCORE scoring system.
Methods: A retrospective study was undertaken by reviewing the case notes of patients who underwent CABG from 2003 to 2008 under Caribbean Heart Care. Data collected included age, sex, smoking status, comorbidities, chronic pulmonary disease, extracardiac arteriopathy, neurologic disease, previous cardiac surgery, serum creatinine, active endocarditis, critical preoperative state, and mode of surgery. Predicted mortality was calculated with the EuroSCORE, the model was calibrated by Hosmer-Lemeshow analysis, and the discriminant function was analyzed by using the receiver operating characteristic (ROC) curve.
Results: We studied 1082 patients who underwent CABG, 75.6% of whom were of Asian Indian ethnicity. The overall mean (±SD) EuroSCORE was 2.87 ± 2.1. The predicted perioperative mortality rate was 2.3%, and the observed mortality rate was 1.2%. The overall standardized mortality ratio was 0.52. Eighty-six percent of the patients underwent off-pump CABG. Hosmer-Lemeshow analysis showed that the system calibrated well to our case mix (Hosmer-Lemeshow value, 6.87; degrees of freedom, 8; P = .551). The EuroSCORE discriminated patient outcomes well, as shown by the area under the ROC curve (0.78). Age and ethnicity did not influence the outcome.
Conclusions: The outcomes of CABG surgery patients are good in Trinidad and Tobago and are comparable to standards in developed countries when evaluated with the EuroSCORE. The proportion of patients undergoing off-pump CABG is high.
References
Beneti FJ, Naselli G, Wood M, Geffner L. 1991. Direct myocardial revascularization without extracorporeal circulation; experience in 700 patients. Chest 100:312-6.nBuffalo E, de Andrade CS, Branco JN, Teles CA, Aguiar LF, Gomes WJ. 1996. Coronary artery bypass grafting without cardiopulmonary bypass. Ann Thorac Surg 61:63-6.nChen CC, Wang CC, Hsieh SR, Tsai HW, Wei HJ, Chang Y. 2004. Application of European system for cardiac operative risk evaluation (EuroSCORE) in coronary artery bypass surgery for Taiwanese. Interact Cardiovasc Thorac Surg 3:562-5.nHariharan S, Chen D, Merritt-Charles L. 2006. Off-pump coronary artery bypass surgery: anaesthetic implications and the Trinidad experience. West Indian Med J 55:298-304.nHariharan S, Fakoory MT, Harris A, Moseley HS, Kumar AY. 2005. Outcome of elderly patients following open-heart surgery in a developing country. Int J Clin Pract 59:953-7.nHoogeveen RC, Gambhir JK, Gambhir DS, et al. 2001. Evaluation of Lp[a] and other independent risk factors for CHD in Asian Indians and their USA counterparts. J Lipid Res 42:631-8.nKeenan TD, Abu-Omar Y, Taggart DP. 2005. Bypassing the pump: changing practices in coronary artery surgery. Chest 128:363-9.nLip GYH, Rathore VS, Katira R, Watson RD, Singh SP. 1999. Do Indo-Asians have smaller coronary arteries? Postgrad Med J 75:463-6.nMeharwal ZS, Mishra YK, Kohli V, et al. 2003. Multivessel off-pump coronary artery bypass: analysis of 4953 cases. Heart Surg Forum 6:153-9.nMortasawi A, Arnrich B, Rosendahl U, et al. 2002. Is age an independent determinant of mortality in cardiac surgery as suggested by the Euro-SCORE? BMC Surg 2:8.nNashef SAM, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R, the EuroSCORE study group. 1999. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 16:9-13.nParolari A, Pesce LL, Trezzi M, et al. 2009. Performance of EuroSCORE in CABG and off-pump coronary artery bypass grafting: single institution experience and meta-analysis. Eur Heart J 30:297-304.nReid C, Billah B, Dinh D, et al. 2009. An Australian risk prediction model for 30-day mortality after isolated coronary artery bypass: the AusSCORE. J Thorac Cardiovasc Surg 138:904-10.nShennib N. 2001. A renaissance in cardiovascular surgery: endovascular and device-based revascularization. Ann Thorac Surg 72:S993-4.nVan Dijk D, Spoor M, Hijman R, et al, for the Octopus Study Group. 2007. Cognitive and cardiac outcomes 5 years after off-pump vs on-pump coronary artery bypass graft surgery. JAMA 297:701-8.nYap CH, Reid C, Yii M, et al. 2006. Validation of the EuroSCORE model in Australia. Eur J Cardiothorac Surg 29:441-6.nYoun YN, Kwak YL, Yoo KJ. 2007. Can the EuroSCORE predict the early and mid-term mortality after off-pump coronary artery bypass grafting? Ann Thorac Surg 83:2111-7.nZheng Z, Li Y, Zhang S, Hu S, and on behalf of the Chinese CABG Registry Study. 2009. The Chinese Coronary Artery Bypass Grafting Registry Study: how well does the EuroSCORE predict operative risk for Chinese population? Eur J Cardiothorac Surg 35:54-8.n
