Published online Mar 26, 2025. doi: 10.4330/wjc.v17.i3.100506
Revised: October 24, 2024
Accepted: March 13, 2025
Published online: March 26, 2025
Processing time: 214 Days and 19 Hours
The EuroSCORE II is a globally accepted tool for predicting mortality in patients undergoing cardiac surgery. However, the discriminative ability of this tool in non-European populations may be inadequate, limiting its use in other regions.
To evaluate the performance of EuroSCORE II in patients undergoing coronary artery bypass graft (CABG) surgery at a hospital in Bogotá, Colombia.
An observational, analytical study of a retrospective cohort was designed. All patients admitted to Hospital Universitario Mayor Méderi who underwent CABG between December 2015 and May 2020 were included. In-hospital mortality was the primary outcome evaluated. Furthermore, the performance of EuroSCORE II was assessed in this population.
A total of 1009 patients were included [median age 66 years IQR = 59-72, 78.2% men]. The overall in-hospital mortality was 5.5% (n = 56). The median mortality predicted using EuroSCORE II was 1.29 (IQR = 0.92-2.11). Non-ST-segment elevation myocardial infarction was the most common preoperative diagnosis (54.1%), followed by ST-segment elevation myocardial infarction (19.1%) and unstable angina (14.3%). Urgent surgery was performed in 87.3% of the patients (n = 881). Mortality rates in each group were as follows: Low risk 6.0% (n = 45, observed-to-expected (O/E) ratio, 5.6), moderate risk 3.0% (n = 5, O/E ratio 1.17), high risk 5.0% (n = 4, O/E ratio 0.94), and very high risk 7.6% (n = 2, O/E ratio 0.71). The overall O/E ratio was 4.2. The area under the curve of EuroSCORE II was 0.55 [95% confidence interval: 0.48-0.63]
EuroSCORE II exhibited poor performance in this population owing to its low discriminative ability. This finding may be explained by the fact that the population comprised older individuals with higher ventricular function impairment. Moreover, unlike the population in which this tool was originally developed, most patients were not electively admitted for the surgery.
Core Tip: Evaluating the EuroSCORE II in specific populations is crucial owing to the significant discrepancies reported between observed and expected mortality rates. Accurate assessment tools are essential for understanding and alleviating mortality rates in hospitals in developing countries. Tailoring EuroSCORE II to local contexts can facilitate informed public health decisions, optimize resource allocation, and ultimately enhance patient outcomes within healthcare systems.