Outcome evaluation of coronary artery bypass grafting surgery applying the EuroSCORE in a Caribbean developing country.
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.
Department of Clinical Surgical Sciences, Faculty of Medical Sciences, The University of the West Indies-St. Augustine, Eric Williams Medical Sciences Complex, Mount Hope, Trinidad, West Indies. uwi.hariharan@gmail.com
Seetharaman
S
Hariharan
Deryk
D
Chen
Michelle
M
Vialva
Hermes
H
Exeter
Imesha
I
Billingy
Kelly-Ann
KA
Bobb
Botshelo
B
Rammekwa
Danielle
D
Reid
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017691:Caribbean Region / Q000453:epidemiology; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends