Reference : E.B. Fortescue and al. Development and validation of a clinical prediction rule for major adverse outcomes in coronary bypass grafting. Am J cardiol. 2001;88:1251-58.
Beta and alpha coefficients have not been still published (by courtesy of Elizabeth Fortescue).
Major Adverse Outcome
A major adverse outcome was defined as any of the following occuring after the CABG procedure and before discharge from the hospital:
- Death
- Renal failure (defined as new dialysis)
- Myocardial infarction (defined as chest pain, nausea, diaphoresis, or hypotension in association with the development of new Q wawes)
- Cardiac Arrest (defined as use of of Advanced Cardiac Life Support or cardiac arrest or respiratory arrest)
- Stroke (defined as an abrupt onset loss of neurologic function, caused by ischemia, persisting >= 24 hours or leaving residual signs)
- Coma (defined as a state of complete mental unresponsiveness with no evidence of purposeful motor, verbal,or ocular responses to stimulation).
If >= 1 of the subtypes of major adverse outcome was present, the summary variable "any major adverse outcome" was considered present. Each patient was counted only once in the analyses regardless of the total number of major adverse outcomes present in that patient.
Patient population
All adult patients( n= 9,498) who underwent a CABG and no other concomitant surgery at 12 U.S. academic medical centers from 1993 to 1995.
Potential risk factors definitions
- Cardiogenic shock was defined as systolic blood pressure < 80 mmHg requiring treatment with pressors and / or inotropes.
- Stroke history required a documented history of cerebrovascular accident, stroke or transient ischemic attack that resulted in abnormalities in vision, speech, sensation or motor function, and/or an history of carotid surgery.
- C.O.P.D. was defined as COPD or asthma requiring inhalers, aminophyline or steroids.
- Liver disease was defined as the presence of cirrhosis, chronic active hepatitis, or primary biliary cirrhosis, with any of the following sequelae : ascites, oesophageal varices, portal hypertension, or active hepatic encephalopathy.
- Emergent priority : medical factors related to the patient's cardiac disease dictate that surgery should be performed within hours to avoid unnecessary morbidity or death. Examples : failed PTCA with acute coronary insufficiency and/or hemodynamic instability, similar situation in absence of PTCA. This case should take precedence in time over an elective case, open a new room, or be done at night, if necessary.
- Urgent priority : medical factors require patient to stay in hospital to have operation before discharge. The risk of immediate morbidity and death are not present. Examples : threatening pathologic anatomy such as high grade left main coronary disease, particularly with moderately severe symptoms or history of life-threatening arrhythmia (VF) related to ischemia. May have intra-aortic balloon pump or intravenous nitroglycerin as part of treatment program. This case might be done in the next available surgical slot but would not necessarily take precedence over an elective case and could possibly wait for several days.
- Elective priority : Medical factors indicate the need for operation but the clinical picture allows discharge from the hospital with readmission at a later date for more elective surgery. Little risk of incurring morbidity or death outside of the hospital with good medical management and restricted physical activities.
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| Risk Score |
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| Any Major Adverse outcome | ||||||
| Derivation set ( total n= 6237)) |
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| Validation set (total n = 3261) |
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| Death | ||||||
| Derivation set (total n = 6237) |
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| Validation set (total n = 3261) |
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