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Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia
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Table of Contents
LETTER TO EDITOR  
Year : 2013  |  Volume : 16  |  Issue : 4  |  Page : 299-300
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"


1 Department of Cardiac Anesthesia, Durdans Heart Surgical Centre, Alfred Place, Colombo 03, Sri Lanka
2 Department of Cardiac Anesthesia, CN Centre, All India Institute of Medical Sciences, New Delhi, India

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Date of Web Publication1-Oct-2013
 

How to cite this article:
Malik M, Chauhan S. 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". Ann Card Anaesth 2013;16:299-300

How to cite this URL:
Malik M, Chauhan S. 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". Ann Card Anaesth [serial online] 2013 [cited 2019 Dec 9];16:299-300. Available from: http://www.annals.in/text.asp?2013/16/4/299/119186


The Editor,

We read with interest the article "the application of European system for cardiac operative risk evaluation II (EuroSCORE II) and Society of Thoracic Surgeons risk score for risk stratification in Indian patients undergoing cardiac surgery" [1] and support the proposal of forming a national database and risk stratification tools to provide better quality health-care to cardiac surgical patients in India.

However, we have a few points to mention:

  1. The applicability of additive EuroSCORE was questioned by us [2] after observing a discrepancy between predicted and observed mortality in 1000 consecutive patients undergoing cardiac surgery. We attributed the discrepancy in results to the following reasons: Younger age of surgical patients; Delayed presentation; Higher number of rheumatic heart disease (RHD) patients in the study than coronary artery disease patients, and higher prevalence of pulmonary artery hypertension in Indian cohorts than the European population. However, the authors have ascribed no reasons for the discrepancy in results between study cohort and EuroSCORE II cohort. One of the implications of these results can be an exceptionally good quality of care by the concerned surgical team. In that scenario, the mortality rates of low risk and moderate risk category patients should be less, which is not the case. Borde et al., have shown overestimation of mortality risk in high-risk patients only and accurate estimation in low and moderate risk patients.
  2. The authors have pointed out only 10% of their patients had RHD, which is a major cause for patients undergoing cardiac surgery in India. Our study had approximately 571 (57.1%) patients with RHD. The authors did not include patients undergoing off-pump coronary artery bypass grafting (CABG). One of the largest series of off-pump CABG is from India [3] and India is one of the leading countries in terms of the number of off-pump CABG performed annually. Therefore, we believe that the population sample studied by the authors does not truly reflect Indian population.
  3. The authors have also shown that Indian patients are younger at the time of cardiac surgery. In addition, they found a higher prevalence of peripheral arterial disease, chronic obstructive pulmonary disease and history of cerebrovascular accident at a young age, which is alarming. However, our study showed low prevalence of these factors, the discrepancy could be ascribed to the inclusion of the higher number of patients with RHD and younger age at surgery. [2]
EuroSCORE II was initially launched as EuroSCORE 2010 and its applicability and suitability was questioned by us in a correspondence to this journal and had proposed to formulate a national database to build our own risk stratification model. [4] Given the fact that many centers are reluctant to reveal their mortality and morbidity statistics, the proposal remains a distant dream.

 
   References Top

1.Borde D, Gandhe U, Hargave N, Pandey K, Khullar V. The application of European system for cardiac operative risk evaluation II (EuroSCORE II) and society of thoracic surgeons (STS) risk-score for risk stratification in Indian patients undergoing cardiac surgery. Ann Card Anaesth 2013;16:163-6.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.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.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.Trehan N, Mishra M, Sharma OP, Mishra A, Kasliwal RR. Further reduction in stroke after off-pump coronary artery bypass grafting: A 10-year experience. Ann Thorac Surg 2001;72:S1026-32.  Back to cited text no. 3
[PUBMED]    
4.Malik M, Chauhan S, Gharde P, Malik V. What new will EuroSCORE 2010 offer? Ann Card Anaesth 2011;14:60-1.  Back to cited text no. 4
[PUBMED]  Medknow Journal  

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Correspondence Address:
Madhur Malik
Department of Cardiac Anesthesia, Durdans Heart Surgical Centre, Alfred Place, Colombo 03
Sri Lanka
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.119186

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Authors of Document Borde, D., Gandhe, U., Hargave, N., Pandey, K., Khullar, V.
Source of the Document Annals of Cardiac Anaesthesia. 2013;
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