Sanon et al reported the Texas Heart Institute Risk Scoring Technique (THIRST) for a patient undergoing cardiovascular surgery. This can help to identify a patient at increased risk for in-hospital mortality. The authors are from the Texas Heart Institute. and University of Texas Health Science Center at San Antonio.
Patient selection: adult from 50 to 89 years old
Outcome: in-hospital mortality
Parameters:
(1) age
(2) left ventricular ejection fraction
(3) congestive heart failure
(4) renal insufficiency
(5) surgical acuity
(6) aortic valve surgery
(7) mitral valve surgery
(8) repeat valve surgery
(9) repeat CABG
(10) repeat aortic aneurysm repair
(11) concomitant aortic aneurysm repair
(12) concomitant left ventricular aneurysm repair
(13) preoperative IABP support
(14) history of TIA
(15) history of acute MI
(16) unstable angina
(17) peripheral vascular disease
(18) diabetes mellitus
(19) 3-vessel coronary artery disease
|
Parameter |
Finding |
Points (Recalibrated) |
|
age |
50 to 59 years |
3 |
|
|
60 to 69 years |
6 |
|
|
70 to 79 years |
9 |
|
|
80 to 89 years |
12 |
|
LVEF |
>= 40% |
0 |
|
|
< 40% |
2 |
|
CHF |
no |
0 |
|
|
yes |
4 |
|
renal insufficiency |
no |
0 |
|
|
yes |
6 |
|
surgical acuity |
urgent (within 48 hours) |
9 |
|
|
elective |
0 |
|
aortic valve surgery |
no |
0 |
|
|
yes |
5 |
|
mitral valve surgery |
no |
0 |
|
|
yes |
5 |
|
repeat valve surgery |
no |
0 |
|
|
yes |
4 |
|
repeat CABG |
no |
0 |
|
|
yes |
9 |
|
repeat aortic aneurysm repair |
no |
0 |
|
|
yes |
15 |
|
concomitant aortic aneurysm repair |
no |
0 |
|
|
yes |
9 |
|
concomitant left ventricular aneurysm repair |
no |
0 |
|
|
yes |
7 |
|
preop IABP support |
no |
0 |
|
|
yes |
7 |
|
history of TIA |
no |
0 |
|
|
yes |
3 |
|
history of AMI |
no |
0 |
|
|
yes |
3 |
|
unstable angina |
no |
0 |
|
|
yes |
2 |
|
peripheral vascular disease |
no |
0 |
|
|
yes |
2 |
|
diabetes mellitus |
no |
0 |
|
|
yes |
2 |
|
3-vessel CAD |
no |
0 |
|
|
yes |
2 |
where:
• Scoring some procedures uncertain - repeat valve surgery and mitral/aortic valve surgery; repeat aneurysm repair and aneurysm repair; aneurysm repair alone.
total score =
= SUM(points for all 19 parameters)
Interpretation:
• minimum score: 3
• maximum score: 105 (if all answers independent)
• The higher the score the greater the risk of in-hospital mortality.
|
Score |
Risk Group |
|
< 15 |
low |
|
15 to 25 |
medium |
|
> 25 |
high |
value of X =
= (0.09 * (score)) - 5
probability of in-hospital mortality =
= 1 / (1 + EXP((-1) * X))
Specialty: Cardiology, Surgery, general
