Staat et al developed a simple clinical score for predicting severe morbidity after coronary artery bypass graft (CABG) surgery. This can help identify patients at significant risk for postoperative complications. The authors are from Lyon, France.
Severe morbidity = death or significant post-operative event
Significant post-operative events:
(1) low cardiac output
(2) necessity to place an intra-aortic balloon pump
(3) myocardial infarction
(4) mechanical ventilation for more than 48 hours
(5) severe pneumonia
(6) other severe infection
(7) acute renal failure
(8) excessive bleeding
(9) unplanned return to surgery
(10) central nervous system complication (like stroke)
Exclusion: Concurrent cardiac or noncardiac surgery with the coronary artery bypass.
Parameters for score based on pre-operative condition:
(1) right heart failure
(2) ventricular arrhythmias
(3) type of procedure
(4) chronic obstructive pulmonary disease (COPD)
(5) body mass index in kg per square meter
(6) ST changes in pre-operative ECG
Parameter |
Finding |
Points |
---|---|---|
symptomatic right heart failure |
present |
7 |
|
absent |
0 |
ventricular arrhythmias |
present |
4 |
|
absent |
0 |
CABG procedure |
reoperation |
4 |
|
first time |
0 |
chronic obstructive pulmonary disease |
present |
3 |
|
absent |
0 |
body mass index |
< 24 |
2 |
|
>= 24 |
0 |
ST changes on pre-operative ECG |
present |
2 |
|
absent |
0 |
clinical score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 22
• The higher the score the greater the risk of severe morbidity.
Clinical Score |
Observed Morbidity |
---|---|
0 |
13% |
2 |
41% |
3 |
53% |
4 |
63% |
5 |
68% |
6 |
80% |
7 |
85% |
>= 8 |
100% |
from Table 1, page 964
Performance:
• negative predictive value: 87%
• area under the ROC: 0.77 (development set), 0.65 (validation set)
Purpose: To predict the risk of a significant post-operative complication in a patient having coronary artery surgery using the clinical score of Staat et al.
Specialty: Cardiology, Surgery, general
Objective: severity, prognosis, stage
ICD-10: I20-I25,