Huijskes et al developed models for predicting outcomes following coronary artery bypass graft and/or cardiac valve surgery. One model describes the risk for major adverse cardiac events (MACE). The authors are from Amphia Hospital in Breda, The Netherlands.
MACE encompasses in-hospital death, perioperative myocardial infarction, or ventricular arrhythmia (tachycardia or fibrillation).
Parameters:
(1) age in years
(2) extracardiac arteriopathy (arteriopathy or a history of a vascular intervention in the past, presumably including peripheral arterial disease and vasculitis)
(3) pulmonary hypertension
(4) myocardial infarction more than 30 days ago
(5) myocardial infarction (AMI) in the past 24 hours
(6) history of previous cardiac surgery
(7) timing for the surgery
(8) type of surgery
|
Parameter |
Finding |
Points |
|
age |
<=60 |
0 |
|
|
> 60 |
see below |
|
extracardiac arteriopathy |
no |
0 |
|
|
yes |
2 |
|
pulmonary hypertension |
no |
0 |
|
|
yes |
2 |
|
MI > 30 days ago |
no |
0 |
|
|
yes |
2 |
|
AMI in past 24 hours |
no |
0 |
|
|
yes |
9 |
|
history of previous cardiac surgery |
no |
0 |
|
|
yes |
6 |
|
timing for the surgery |
routine or urgent |
0 |
|
|
emergency |
5 |
|
type of surgery |
combined CABG and mitral valve surgery |
6 |
|
|
combined CABG and aortic valve surgery |
5 |
|
|
other |
0 |
points for age over 60 =
= ROUNDUP((age) – 60)/5,0)
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score 40 or more
• The higher the score the greater the risk for a major adverse cardiac event.
|
Total Score |
Risk |
|
0 to 2 |
low |
|
3 or 4 |
low to moderate |
|
5 or 6 |
moderate |
|
7 to 10 |
moderate to high |
|
11 or more |
high |
The authors also gave the equation from multivariate analysis:
|
Parameter |
Beta |
|
age, per 5 years after 60 years of age |
0.15 |
|
extracardiac arteriopathy |
0.28 |
|
pulmonary hypertension |
1.33 |
|
history of prior cardiac surgery |
0.89 |
|
MI > 30 days ago |
0.26 |
|
AMI in past 24 hours |
1.43 |
|
emergency procedure |
0.43 |
|
combined CABG and mitral valve procedure |
0.97 |
|
combined CABG and aortic valve procedure |
0.70 |
|
coefficient |
-2.29 |
Specialty: Cardiology, Surgery, general
ICD-10: ,
