Predictive Clinical Score of Staat et al for Severe Morbidity After Coronary Artery Surgery

Severe morbidity = death or significant post-operative event

Significant post-operative events:

(1) low cardiac output

(2) necessity to place an intra-aortic balloon pump

(3) myocardial infarction

(4) mechanical ventilation for more than 48 hours

(5) severe pneumonia

(6) other severe infection

(7) acute renal failure

(8) excessive bleeding

(9) unplanned return to surgery

(10) central nervous system complication (like stroke)

Exclusion: Concurrent cardiac or noncardiac surgery with the coronary artery bypass.

Parameters for score based on pre-operative condition:

(1) right heart failure

(2) ventricular arrhythmias

(3) type of procedure

(4) chronic obstructive pulmonary disease (COPD)

(5) body mass index in kg per square meter

(6) ST changes in pre-operative ECG

clinical score =

= SUM(points for all 6 parameters)

Interpretation:

• minimum score: 0

• maximum score: 22

• The higher the score the greater the risk of severe morbidity.

from Table 1, page 964

Performance:

• negative predictive value: 87%

• area under the ROC: 0.77 (development set), 0.65 (validation set)