ABSTRACT
Aim of the study was to evaluate patients pre operatively with Euroscoring System to judge the end point, hospital mortality in CABG done in last ten years by a single surgeon. Form June 1989 to June 1999 the data of 262 cases of CABG done was collected on the data sheet each case was scored pre operatively with Euroscoring System. The different groups were made from this system, Group 1 Score 0-1, Group 2 Score 3-4, Group 3 Score 5-6, Group 4 Score 7-8, Group 5 >9. Another Grouping was Group 1 score 0-5, and Group 2 score 6-10 and Group 3 score 11-15. Pre op data was collected and analyzed by SPSS Version 7.5. The End point was hospital mortality. In this group of 262 patients, the age range was 25-77 with the mean 52.41 years, 248 [94.7 percent] were males and 14 [5.3 percent] were females. In this whole cohort of patients 227 [86.6 percent] were having stable angina pectoris and 35 [13.4 percent] were having unstable angina Pre op angina status was Class 1 in 5 [1.9 percent], Class II 88 [33.6 percent], Class III 132 [50, 4 percent] and Class IV were 37 [14.1 percent]. There were 116 [44.3 percent] hypertensive, 56 [21.4 percent] were diabetics and 9 [3.4 percent] were obese. Recent myocardial Infarction was there in 9 [3.4 percent] of cases, the old non Q- wave infarction was present in 18 [6.9 percent] of cases and Q - wave infarction was present in 42 [16 percent] of cases. Pre op Ejection fraction was good in [EF >50 percent] in 204 [77.9 percent] cases, Fair [EF 30-49 percent] in 50 [19.1 percent] cases, poor [EF<30 percent] in 8 [3.1 percent] cases. Pre op support of intra-aortic balloon counterpulsation [IABP] was used in 3 [1.1 percent], pre operative ventilation was done in 1 [0.4 percent], Inotropic support was present in 4 [1.5 percent], and vasodilators were given in 14 [5.3 percent] cases, Elective surgery was done in 92 percent, urgent in 4 percent, emergency in 3 percent and salvage surgery was done in 1 percent of cases. Mortality in Euroscore Group I [Score 0-1] was 3.1 percent, in Group II [Score 2-3] 9.4 percent, in Group III [Score 4-5] 19 percent, in Group IV [Score 6-7] 25 percent and in Group VI [Score >9] the mortality was 60 percent. The Euro score from 0-5 was having 6.1 percent mortality, the score from 6-10 was having 20 percent and the score from 11-15 was having 80 percent mortality. On Logistic regression overall predictive accuracy of Euroscoring is very good [90 percent]. Predictive accuracy, 37 percent of deaths could be explained on the existing variables, positive predictive value is 19.05 percent and negative predictive value is 99.17 percent. The predictive accuracy of Euroscoring changes with various risk groups, in low risk Groups [Score 0-5] and [Score 6-10] Euroscore predicts survival more accurately. In high risk Group [11-15] Euroscoring better predicts mortality rather than survival. The factors included in permutations of Euroscore explain only 37 percent of the observed mortality. It is noted that the observed mortality is consistently higher than that predicted by logistic regression. Euroscoring is a good tool of risk stratification to predict the out come but not ideally suited to our clinical circumstances. Though we have documented an overall predictive accuracy of 92 percent, it is limited in its usefulness because it does not take into consideration certain risk factors found to be important in our patient population. In addition, the relative weight assigned to various risk factors in scoring needs to be readjusted for our patient population in the light of observations made on our patient population. There is a need to develop a scoring system of our own which could be used for better prediction of outcomes in our clinical circumstances