Hannan et al reported mortality risk scores for patients undergoing isolated valve or valve plus CABG procedures. These can help to identify a patient who may require more aggressive management. The authors are from State University of New York at Albany, New York University Medical Center, University of Connecticut, Drexel University, Columbia-Presbyterian Medical Center New York, Medical University of Ohio Toledo and Albana College of Pharmacy and Health Sciences.
Patient selection: valve surgery plus coronary artery bypass graft (CABG)
Parameters:
(1) type of surgery
(2) age in years
(3) sex and body surface area (BSA)
(4) hemodynamic status
(5) left ventricular ejection fraction in percent
(6) history of previous AMI
(7) endocarditis
(8) peripheral vascular disease disease
(9) serum creatinine or dialysis
(10) left main coronary artery disease
(11) previous open heart surgery
(12) previous PCI before this admission
Parameter
Finding
Points
type of surgery
aortic valve replacement and CABG
0
mitral valve repair and CABG
0
mitral valve replacement and CABG
2
multiple valve repair or replacement and CABG
4
age in years
< 75 years
0
75 to 84 years
2
>= 85 years
5
sex and BSA
male and BSA < 2.5 sq m
0
male and BSA >= 2.5 sq m
2
female and BSA < 1.5
2
female and BSA 1.5 to 1.74
1
female and BSA 1.75 to 2.24
0
female and BSA >= 2.25
5
hemodynamic status
stable
0
unstable
3
LVEF
>= 30%
0
< 30%
2
history of previous AMI
none
0
within past 24 hours
4
from 1 to 14 days
2
> 14 days
0
endocarditis
no
0
yes
3
peripheral vascular disease
no
0
yes
2
serum creatinine
< 2.1 mg/dL
0
2.1 to 2.5 mg/dL
2
> 2.5 mg/dL
5
on dialysis
6
left main coronary artery disease
no
0
yes
1
previous open-heart surgery
no
0
yes
2
previous PCI before this admission
no
0
yes
1
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 38
• The higher the score the greater the in-hospital and 30-day mortality rate.
Total Score
Predicted Risk
0 or 1
2%
2
3%
3
4%
4
5%
5
6%
6
8%
7
10%
8
13%
9
17%
10
21%
11
26%
12
32%
13
38%
>= 14
87%
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