Patients at risk for morbidity and mortality following coronary artery bypass graft (CABG) surgery can be identified using a clinical risk score developed at Allegheny General Hospital in Pittsburgh.
NOTE: The score appears to apply to patients having bypass graft surgery only and not concurrent valve surgery.
Parameter |
Finding |
Points |
---|---|---|
age |
< 65 years |
0 |
|
65 - 69 years |
1 |
|
70 - 74 years |
2 |
|
>= 75 years |
3 |
gender |
male |
0 |
|
female |
1 |
operation timeliness |
elective |
0 |
|
urgent |
4 |
|
emergency |
5 |
reoperation |
no |
0 |
|
yes |
1 |
diabetes mellitus |
non-insulin dependent |
1 |
|
insulin dependent |
2 |
renal dysfunction |
creatinine 1.5 - 1.9 mg/dL |
1 |
|
creatinine > 1.9 mg/dL |
2 |
left ventricular dysfunction |
ejection fraction >= 30% |
0 |
|
severe (ejection fraction < 30%) |
4 |
serum albumin |
>= 4.0 g/dL |
0 |
|
< 4 g/dL (paper says < 4 mg/dL which seems an error) |
1 |
BUN |
<= 29 mg/dL |
0 |
|
> 29 mg/dL |
1 |
Additional Risk Factors |
Points |
---|---|
cardiogenic shock |
7 |
congestive heart failure |
1 |
cardiomegaly |
2 |
atrial arrhythmia |
1 |
catheterization induced coronary closure |
4 |
peripheral vascular disease |
2 |
cerebrovascular disease |
1 |
anemia |
1 |
chronic obstructive pulmonary disease |
1 |
low body mass index |
1 |
clinical risk score =
= SUM(points for parameters) + SUM(points for additional risk factors)
Interpretation:
• minimum score: 0
• maximum score: 41 (20 + 21)
Clinical Risk Score |
Mortality Risk |
Percent Predicted |
---|---|---|
0 - 4 |
low |
0.2% |
5 - 8 |
average |
2% |
9 - 11 |
moderate |
6% |
12 - 18 |
high |
30% |
>= 19 |
extremely high |
95% |
(Table 3 and Figure 1, page 1150)
Clinical Risk Score |
Morbidity Risk |
Percent Predicted |
---|---|---|
0 - 2 |
low |
20% |
3 - 5 |
moderate |
50% |
6 - 8 |
high |
74% |
>= 9 |
extremely high |
93% |
(Table 3 and Figure 2, page 1150)
Purpose: To use a clinical risk score to estimate the risk for morbidity and mortality in a patient undergoing coronary artery bypass graft (CABG) surgery.
Specialty: Cardiology, Surgery, general
Objective: risk factors, severity, prognosis, stage
ICD-10: I20-I25, I97.0,