Calculator for Risk of Emergency CABG and Death in the Catheterization Laboratory

Procedure Information

Select patient gender at birth (female or male).

Labs - Last Prior to PCI

mg/dl
Use closest creatinine to PCI.
g/dl
Use closest hemoglobin prior to PCI.

Comorbidity

Indicate if the patient has a history confirming any form of tobacco use in the past one month. This includes cigarette, cigars, tobacco chew, pipes, etc. (this does not include marijuana).
Indicate if the patient has hypertension documented ≥1 of the following:
  1. History of hypertension diagnosed and treated with medication, diet and/or exercise.
  2. Blood pressure greater than 140 systolic or 90 diastolic on at least 2 occasions.
  3. Currently on antihypertensive pharmacologic therapy.
Insulin treatment (includes any combination of insulin).
Diet treatment or oral agent treatment (includes oral agent with/without diet treatment).
Indicate if the patient has a history of congestive heart failure (CHF) documented in the medical record. History is defined as anytime prior to two weeks before the current date of admission. Besides physician documentation of the CHF history, CHF can also be defined by one of the following:
  1. Paroxysmal nocturnal dyspnea (PND)
  2. Dyspnea on exertion (DOE) due to heart failure
  3. Chest X-Ray (CXR) showing pulmonary congestion
  4. Pedal edema or dyspnea treated with medical therapy for heart failure
Indicate if the patient has a history of peripheral vascular disease. This can include:
  1. Claudication either with exertion or at rest.
  2. Amputation for arterial vascular insufficiency.
  3. Aorto-iliac occlusive disease reconstruction, peripheral vascular bypass surgery, angioplasty or stent; or percutaneous intervention to the extremities.
  4. Documented aortic aneurysm. (AAA)
  5. Positive non-invasive/invasive test.
  6. Renal stenosis
Was the patient on dialysis for renal failure prior to this PTCI?
Current mitral valve regurgitation of at least grade 2 or greater, mitral valve area < 1.5 cm2, aortic valve regurgitation of at least grade 2 or greater, aortic valve area ≤1.0 cm2.
Any history of GI bleed including peptic ulcer disease that may influence clinical management during this hospitalization (recent=within 30 days).
Diagnosis made by physician. Patient on chronic pharmacologic therapy and/or have a FEVI less than 75 percent of predicted value.
Indicate if the patient has cerebrovascular disease, documented by any one of the following:
  1. Cerebrovascular Accident (CVA): Patient has a history of stroke, i.e., loss of neurological function caused by an ischemic event with residual symptoms at least 24 hours after onset.
  2. Reversible Ischemic Neurologic Deficit (RIND): Patient has a history of loss of neurological function caused by ischemia with symptoms at least 24 hours after onset but with complete return of function within 72 hours.
  3. Transient Ischemic Attack (TIA): Patient has a history of loss of neurological function caused by ischemia that was abrupt in onset but with complete return of function within 24 hours.
  4. Unresponsive Coma greater than 24 hours: Patient experienced complete mental unresponsiveness and no evidence of psychological or physiologically appropriate responses to stimulation.
  5. Non-invasive/invasive Carotid Test with greater than 75% occlusion.
  6. Previous Carotid artery surgery. (CEA)
Prior to PCI or history of either paroxysmal atrial fibrillation or chronic atrial fibrillation.
Any history of either out of hospital or in-hospital cardiac arrest. Cardiac arrest as evidenced by potentially lethal arrhythmia requiring cardioversion, defibrillation or CPR.
Indicate if the patient has had at least one documented previous ST or non-ST MI eight or more days prior to this admission.
Indicate whether the patient has had a previous Percutaneous Coronary Intervention (PCI) of any type (balloon angioplasty, atherectomy, stent, thrombectomy or other), performed prior to the current admission.

Cardiac Status

  1. Emergent: The patient’s clinical status includes any of the following:
    1. Ischemic dysfunction (any of the following)
      1. Ongoing ischemia including rest angina despite maximal medical therapy (medical and/or IABP)
      2. Acute evolving MI within 24 hours before intervention; or
      3. Pulmonary edema requiring intubation.
    2. Mechanical dysfunction (either of the following):
      1. Shock with circulatory support; or
      2. Shock without circulatory support.
  2. Urgent: All of the following conditions are met:
    1. Not elective
    2. Not emergency
    3. Procedure required during same hospitalization in order to minimize chance of further clinical deterioration. (This will include the majority of ACS/USA patients coming through ER. They usually will be started on IV heparin, nitrates, aspirin, cardiac markers and serial ECGs. This also includes patients transferred from outside hospital for PCI).
  3. Non-Urgent: The procedure could be deferred without increased risk of compromised cardiac outcome. (This should include the elective or scheduled patients).
This intervention is part of a staged procedure. Intervention (PCI) to intervention (PCI), not diagnostic cath only.
The patient is undergoing CPR en route to the lab and/or prior to the intervention, including hemodynamically unstable patients.
Was a cardiac arrest the primary indication for the current coronary intervention?
PCI performed in same setting as coronary angiography.
Angina without a change in frequency or pattern for the six weeks prior to this procedure. Angina is controlled by rest and/or oral or transcutaneous meds.
Pain, pressure or discomfort in the chest, neck or arms not clearly exertional or not otherwise consistent with pain or discomfort of myocardial ischemic origin. (Includes patients presenting with CHF symptoms only presumed to be ischemia).
The patient was hospitalized for unstable angina documented in the medical record with serial ECGs and biochemical profiles. One of the following criteria are necessary:
  1. Angina at rest (usually prolonged >20 mins),
  2. New onset (less than two months) exertional angina of at least Canadian Cardiovascular Society Classification (CCSC) class III
  3. Recent (less than two months) acceleration of angina reflected by an increase in severity of at least one CCSC class to at least CCSC class III. The patient must also NOT have any biochemical evidence of myocardial necrosis.
Is the primary indication for coronary intervention a preoperative evaluation and subsequent intervention prior to major noncardiac surgery: e.g. major abdominal surgery, vascular surgery including fem-pop bypass, AAA repair, aortic root repair, ORIF, or knee replacements etc.
Was patient evaluated by thoracic surgery and felt not to be a surgical candidate (for whatever reason i.e. no conduits, severe COPD, small distal vessels, etc.) Must be refused by CV surgeon.
Cardiogenic shock is defined as a sustained (>30 minutes) episode of systolic blood pressure < 90mmHg, and/or cardiac index <2.2 L/min/m2 determined to be secondary to cardiac dysfunction, and/or the requirement for parenteral inotropic or vasopressor agents or mechanical support (e.g., IABP, extracorporeal circulation, ventricular assist devices) to maintain blood pressure and cardiac index above those specified levels. (Def #8005 in NCDR 4.3.1)
Recurrent ventricular tachycardia or ventricular fibrillation prior to PCI (occurred greater than one time).

PCI in the setting of a Myocardial Infarction

Has the patient had a Myocardial Infarction (ST elevation or non-ST elevation) within the previous 7 days?
PCI performed as the primary intervention on the infarct artery i.e. no thrombolytics were administered and PCI was performed within 12 hours of symptom onset.
Mark this box if the time from symptom onset to balloon dilatation was 0 to 6 hours.
Between 6 to 12 hours elapsed from symptom onset to balloon dilatation.
Between 12 to 24 hours elapsed from symptom onset to balloon dilatation.
Greater than 24 hours elapsed from symptom onset to balloon inflation.
Percutaneous coronary intervention performed on the infarct related artery.
Continued symptoms of angina after thrombolytic therapy.
Indicate whether patient received lytic therapy as primary treatment of AMI. Include any combination ½ dose lytics given. (eg, TNK, TPA, and RPA).

Pre-procedural Therapy

Is/Was the patient on intravenous heparin prior to the procedure?

Contraindication

Cardiac Anatomy and Function

%
Indicate as a percentage from 0-100 as obtained from a LV gram, MUGA, ECHO, or estimated from other calculations, based upon available clinical data. If the LVEF is documented as normal without a numerical value, enter 55%. Record the EF obtained closest to PCI.
Visual estimate of saphenous vein graft, left internal mammary artery, right internal mammary artery, including any anastamotic lesions with ≥70% stenoses.
Includes LAD, RCA, LCX, and Ramus. This does not include branches off the native vessels. For example, if a patient has a ≥ 70% lesion in the OM, proximal LCX, and the mid LAD, mark it as two.
Left ventricular end diastolic pressure.

Lesion

Mark the box if the index vessel is a saphenous vein, LIMA, or RIMA graft.
From the origin up to 3 mm.
Visible clot / thrombus.