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CABG Risk of Adverse Outcomes Clinical Prediction Rule

Purpose: To evaluate a patient prior to coronary artery bypass graft (CABG) surgery using the prediction rule of Fortescue et al.

Description

Fortescue et al developed a prediction rule for identifying a patient at risk for major adverse outcomes following coronary artery bypass graft surgery. This can help identify a patient who may be at high risk for post-operative complications. The authors are from Brigham and Women's Hospital, Harvard Medical School, UCLA Medical Center and the Academic Medical Center Consortium Quality Measurement and Management Initiative Working Group.


Major adverse outcomes (Appendix):

(1) death

(2) renal failure

(3) acute myocardial infarction

(4) cardiac arrest

(5) stroke

(6) coma

 

Parameters:

(1) gender

(2) age in years

(3) cardiogenic shock

(4) timing for the surgery

(5) pre-CABG serum creatinine

(6) ejection fraction

(7) history of previous CABG procedure

(8) history of liver disease

(9) history of stroke or transient ischemic attacks (TIA)

(10) history of chronic obstructive pulmonary disease (COPD)

(11) history of hypertension

 

Parameter

Finding

Points

gender of the patient

male

0

 

female

3

age of the patient

< 60 years

0

 

60 - 69 years

5

 

70 to 79 years

8

 

>= 80 years of age

11

cardiogenic shock

absent

0

 

present

10

timing for surgery

emergent

9

 

urgent

2

 

other

0

pre-CABG serum creatinine

<= 1.4 mg/dL

0

 

1.5 - 2.99 mg/dL

5

 

>= 3.0 mg/dL

12

ejection fraction

< 30%

6

 

30 - 49%

3

 

>= 50%

0

history of previous CABG

absent

0

 

present

7

history of liver disease

absent

0

 

present

6

history of stroke or TIA

absent

0

 

present

4

history of COPD

absent

0

 

present

3

history of hypertension

absent

0

 

present

2

 

total score =

= SUM(points for all 11 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 73

• The higher the score the greater the chances of a major adverse outcome.

 

Total Score

Probability of Any Major Adverse Outcome

Probability of Death

0 to 5

2%

0.3%

6 to 10

4%

1%

11 to 15

5-6%

2%

16 to 20

9 - 11%

3%

21 to 25

17-18%

5-8%

>= 26

22-32%

12-17%

from Table 4, page 1255


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Specialty

Objective

ICD-10