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
Purpose: To evaluate a patient prior to coronary artery bypass graft (CABG) surgery using the prediction rule of Fortescue et al.
Specialty: Cardiology, Surgery, general
Objective: severity, prognosis, stage, complications, adverse effects
ICD-10: I20-I25, I97.1,