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| Year : 2011
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: 14 | Issue : 1 | Page
: 60-61 |
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| What new will EuroSCORE 2010 offer? |
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Madhur Malik, Sandeep Chauhan, Parag Gharde, Vishwas Malik
All India Institute of Medical Sciences, New Delhi - 110 029, India
Click here for correspondence address and
email
| Date of Web Publication | 31-Dec-2010 |
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How to cite this article:
Malik M, Chauhan S, Gharde P, Malik V. What new will EuroSCORE 2010 offer?. Ann Card Anaesth 2011;14:60-1 |
The Editor,
EuroSCORE 2010 is an initiative taken up for generating a new risk stratification model for cardiac surgical patients and is expected to cater to the global population as more than 300 centers across different countries in the world have participated in the project. The data collection for the project was done from May 2010 till July 2010. EuroSCORE 2010 is being developed to replace the EuroSCORE model developed in 1999 on the European population, which, on a worldwide application, has shown some lacunae. [1],[2] For the Indian population, the EuroSCORE model has been shown to underpredict the mortality for high-risk patients undergoing cardiac surgery and also lacks the risk factors associated with rheumatic heart disease. [3] Further, a significant difference in the prevalence of risk factors associated with mortality between the Indian and the European population have been noted. [3] The authors had suggested an updation and improvisation of the EuroSCORE model (1999) for application on Indian population.
Our institute was one of the few institutes in India that participated in the EuroSCORE 2010 project. Data collected for EuroSCORE 2010 was similar to the data for the earlier model. No data pertaining to either preoperative liver function tests or congestive heart failure or the time since symptom onset and stage of decompensation have been collected. No biochemical marker of active rheumatic fever such as C-reactive protein, has been included. The only difference between the old and the new EuroSCORE is including the details pertaining to factors such as diabetes mellitus and the type of treatment being received by the patient. It also includes the highest troponin T levels prior to surgery, serum brain natriuretic peptide (BNP) levels, cardiopulmonary bypass (CPB) time and aortic cross clamp time. Except for CPB time and aortic cross clamp time, the other factors are more relevant to coronary artery disease than to rheumatic heart disease, which accounts for a sizeable proportion of the adult cardiac surgeries in India. Serum BNP level is a prognostic marker and is as yet not done in the preoperative period for all patients in India. Longer CPB and aortic cross clamp time are well known risk factors for mortality and may not help in preoperative risk stratification.
There are certain rare intraoperative/postoperative risk factors for mortality, like air embolism and postinduction/postoperative cardiac arrest. No data about these independent causes for mortality have been collected, and it is likely to interfere with the accuracy of prediction of mortality by the model. Mortality due to these rare causes may be erroneously attributed to some other incidental preoperative factor during the analysis of data and the development of this new model.
In view of the increasing number of cardiac surgeries being performed in India and the increasing role of medical insurance in financing the hospital fees, there is a requirement for a risk stratification system customized for the Indian population. The development of such a risk stratification model in India will require a concerted effort by a large number of cardiac surgery centres, both public and private, so as to have a large database of patients for analysis. The database may also help identify the regional differences in the prevalence of risk factors.
Despite these shortcoming in the EuroSCORE 2010 (likely to be available in the next 3-4 months) described above, it may fare better than the earlier EuroSCORE model.
 References | |  |
| 1. | Karthik S, Srinivasan AK, Grayson AD, Jackson M, Sharpe DA, Keenan DJ, et al. Limitations of additive EuroSCORE for measuring risk stratified mortality in combined coronary and valve surgery. Eur J Cardiothorac Surg 2004;26:318-22. 
[PUBMED] [FULLTEXT] |
| 2. | Gogbashian A, Sedrakyan A, Treasure T. EuroSCORE: A systematic review of international performance. Eur J Cardiothorac Surg 2004;25:695-700.
[PUBMED] [FULLTEXT] |
| 3. | Malik M, Chauhan S, Malik V, Gharde P, Kiran U, Pandey RM. Is EuroSCORE applicable to Indian patients undergoing cardiac surgery? Ann Card Anaesth 2010;13:241-5.
[PUBMED]  |
Correspondence Address:
Madhur Malik
Department Of Cardiac Anaesthesia, VIIth Floor, C N Centre, All India Institute of Medical Sciences, New Delhi - 110 029
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0971-9784.74404
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| This article has been cited by | | 1 |
result 1 Document In response to, «the application of European system for cardiac operative risk evaluation II and society of thoracic surgeons risk score for risk stratification in Indian patients undergoing cardiac surgery» |
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| Malik, M., Chauhan, S. | | Source of the Document Annals of Cardiac Anaesthesia. 2013; | | [Pubmed] | |
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