Ivanov et al reported a risk score for adverse events following cardiac surgery. This can help to identify a patient who may require more aggressive management. The authors are from Toronto General Hospital and the University of Toronto.
Patient selection: adult undergoingcardiac surgery
Parameters:
(1) age in years
(2) sex
(3) LVEF in percent
(4) surgical acuity (priority)
(5) history of acute myocardial infarction less than 1 month prior to surgery
(6) redo CABG procedure
(7) triple vessel disease
(8) disease of left main coronary artery
(9) congestive heart failure
(10) renal insufficiency
(11) diabetes
(12) peripheral vascular disease
(13) hypertension
(14) complex valve disease
(15) other pathology being operated on (aneurysm, adult congenital heart, myectomy, septal repair, VSD placement, transplant, etc)
|
Parameter |
Finding |
Points |
|
age in years |
< 65 years |
0 |
|
|
65 to 74 years |
1 |
|
|
>= 75 years |
2 |
|
sex |
male |
0 |
|
|
female |
2 |
|
LVEF in percent |
> 40% |
0 |
|
|
20 to 40% |
2 |
|
|
< 20% |
3 |
|
surgical acuity |
elective |
0 |
|
|
urgent |
1 |
|
|
emergency |
6 |
|
history of recent AMI |
no |
0 |
|
|
yes |
1 |
|
redo CABG |
no |
0 |
|
|
yes |
4 |
|
triple vessel disease |
no |
0 |
|
|
yes |
1 |
|
left main disease |
no |
0 |
|
|
yes |
1 |
|
congestive heart failure |
no |
0 |
|
|
yes |
2 |
|
renal insufficiency |
no |
0 |
|
|
yes |
2 |
|
diabetes |
no |
0 |
|
|
yes |
1 |
|
peripheral vascular disease |
no |
0 |
|
|
yes |
1 |
|
hypertension |
no |
0 |
|
|
yes |
1 |
|
complex valve disease |
no |
0 |
|
|
yes |
2 |
|
other pathology |
no |
0 |
|
|
yes |
2 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 31
|
Total Score |
Risk Group |
Percent Adverse Events |
|
0 or 2 |
low |
3% |
|
3 or 4 |
moderate |
5% |
|
5 to 7 |
high |
9-10% |
|
>= 8 |
extreme |
20-25% |
Specialty: Cardiology
