Reid et al reported the AusSCORE to predict 30-day mortality for adult Australians undergoing isolated coronary artery bypass surgery. This can help to identify a patient who may benefit from more aggressive management. The authors are from Monash University, Royal Melbourne Hospital, St. Vincent's Hospital, Austin Hospital and Geelong Hospital in Australia.
Patient selection: isolated coronary artery bypass graft surgery
Outcome: 30-day mortality
Parameters:
(1) age of the patient in years
(2) NYHA functional class
(3) urgency of the surgery
(4) left ventricular ejection fraction (LVEF)
(5) history of previous CABG
(6) hypercholesterolemia (serum cholesterol > 5 mmol/L or treated for hypercholesterolemia)
(7) peripheral vascular disease
(8) cardiogenic shock
|
Parameter
|
Finding
|
Points
|
Beta Coefficient
|
|
age of the patient
|
< 60 years
|
0
|
0
|
|
|
60 to 69.9
|
2
|
0.7487
|
|
|
70 to 79.9
|
4
|
1.2684
|
|
|
>= 80
|
6
|
1.7318
|
|
NYHA class
|
I or II
|
0
|
0
|
|
|
III
|
2
|
0.7383
|
|
|
IV
|
4
|
1.1998
|
|
urgency
|
elective
|
0
|
0
|
|
|
urgent
|
3
|
0.8760
|
|
|
emergency, salvage
|
5
|
1.4226
|
|
LVEF
|
> 45%
|
0
|
0
|
|
|
30 to 45%
|
3
|
0.7782
|
|
|
< 30%
|
4
|
1.2598
|
|
history of previous CABG
|
no
|
0
|
0
|
|
|
yes
|
3
|
0.8305
|
|
hypercholesterolemia
|
absent
|
0
|
0
|
|
|
present
|
-2
|
-0.065
|
|
peripheral vascular disease
|
absent
|
0
|
0
|
|
|
present
|
3
|
0.7480
|
|
cardiogenic shock
|
absent
|
0
|
0
|
|
|
present
|
3
|
1.0100
|
total score =
= SUM(points for all 8 parameters)
X =
= SUM(points for all 8 parameters) - 6.2913
probability of 30-day mortality =
= 1 / (1 + EXP((-1) * X))
Interpretation:
• minimum additive score: -2
• maximum additive score: 27
• The higher the additive score the greater the risk of 30-day mortality.
|
Additive Score
|
Risk Group
|
Mortality Rate
|
|
< 3
|
low
|
0.2%
|
|
3 to 5
|
moderate
|
1%
|
|
> 5
|
high
|
4.6%
|
Performance:
• The area under the ROC curve is 0.84.
