Dataset: 2.52*

ASCERT Long-Term Isolated CABG Risk Calculator

Definitions

Age

Indicate the patient's age in years, at time of surgery. This should be calculated from the date of birth and the date of surgery, according to the convention used in the USA (the number of birthdate anniversaries reached by the date of surgery). If age is less than 18, the data record will be accepted into the database, but will not be included in the national analysis and report.

Weight (kg)

Indicate the weight of the patient in kilograms closest to the date of surgery.

Height (cm)

Indicate the height of the patient in centimeters.

Creatinine

Indicate the creatinine level closest to the date and time prior surgery. A creatinine level should be collected on all patients, even if they have no prior history. A creatinine value is a high predictor of a patient's outcome and is used in the predicted risk models.

Ejection Fraction

Indicate the percentage of the blood emptied from the ventricle at the end of the contraction. Use the most recent determination prior to the surgical intervention documented on a diagnostic report. Enter a percentage in the range of 1 - 99. If a percentage range is reported, report a whole number using the "mean" (i.e., 50-55%, is reported as 53%). Values reported as: Normal = 60% Good function = 50% Mildly reduced = 45% Fair function = 40% Moderately reduced = 30% Poor function = 25% Severely reduced = 20% NOTE: If no diagnostic report is in the medical record, a value documented in the progress record is acceptable.

Mean Aortic Gradient in mm Hg

Indicate the mean aortic gradient (mm Hg). If unknown, and there is no history of aortic stenosis, enter 0. If unknown and the patient has a history of aortic stenosis, enter 15.

Gender

Indicate the patient's sex at birth as either male or female.

Hispanic or Latino Ethnicity

Indicate if the patient is of Hispanic or Latino ethnicity as determined by the patient / family. Hispanic or Latino ethnicity includes patient report of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

Race - Black / African American

Indicate whether the patient's race, as determined by the patient or family, includes Black / African American. This includes a person having origins in any of the black racial groups of Africa. Terms such as "Haitian" or "Negro" can be used in addition to "Black or African American." Definition source: Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity : The minimum categories for data on race and ethnicity for Federal statistics, program administrative reporting, and civil rights compliance reporting.

(www.whitehouse.gov/omb/fedreg/1997standards.html).

Race – Asian

Indicate whether the patient's race, as determined by the patient or family, includes Asian. This includes a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. Definition source: Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity : The minimum categories for data on race and ethnicity for Federal statistics, program administrative reporting, and civil rights compliance reporting.

(www.whitehouse.gov/omb/fedreg/1997standards.html).

Dialysis

Indicate whether the patient is currently undergoing dialysis.

Diabetes

Indicate whether the patient has a history of diabetes, regardless of duration of disease or need for anti-diabetic agents. Includes on admission or preoperative diagnosis. Does not include gestational diabetes.

Lung Disease

Indicate whether the patient has chronic lung disease, and the severity level according to the following classification: No; Mild: FEV1 60% to 75% of predicted, and/or on chronic inhaled or oral bronchodilator therapy. Moderate: FEV1 50% to 59% of predicted, and/or on chronic steroid therapy aimed at lung disease. Severe: FEV1 <50% predicted, and/or Room Air pO2 < 60 or Room Air pCO2 > 50.

Cerebrovascular Disease

Indicate whether the patient has Cerebro-Vascular Disease, documented by any one of the following: CVA (symptoms > 24 hrs after onset, presumed to be from vascular etiology); TIA (recovery within 24 hrs); Non-invasive carotid test with > 75% diameter occlusion.; or Prior carotid surgery. Does not include neurological disease processes such as metabolic and/or anoxic ischemic encephalopathy.

Immunosuppressive Therapy

Indicate whether the patient has used any form of immunosuppressive therapy within 30 days preceding the operative procedure. This includes, but is not limited to inhaled or systemic steroid therapy and chemotherapy. This does not include topical applications, one time systemic therapy, or preoperative protocol.

Peripheral Vascular Disease

Indicate whether the patient has a history of peripheral arterial disease (includes upper and lower extremity, renal, mesenteric, and abdominal aortic systems). This can include: 1. Claudication , either with exertion or at rest, 2. Amputation for arterial vascular insufficiency, 3. Vascular reconstruction, bypass surgery, or percutaneous intervention to the extremities (excluding dialysis fistulas and vein stripping), 4. Documented aortic aneurysm with or without repair, 5. Positive noninvasive test (e.g., ankle brachial index =< 0.9, ultrasound, magnetic resonance or computed tomography imaging of > 50% diameter stenosis in any peripheral artery, i.e., renal, subclavian, femoral, iliac). Peripheral arterial disease excludes disease in the carotid or cerebrovascular arteries.

Smoking History

Indicate whether the patient is a present smoker, has never smoked, or has not smoked within 1 month prior to the procedure.

Atrial Fibrillation/flutter

Indicate whether atrial fibrillation or flutter is present within two weeks of the procedure.

Congestive Heart Failure and NYHA Class

Indicate the patient's highest New York Heart Association (NYHA) classification within 2 weeks prior to surgery. NYHA classification represents the overall functional status of the patient in relationship to both heart failure and angina. Choose one of the following: - Class I: Patient has cardiac disease but without resulting limitations of ordinary physical activity. Ordinary physical activity (e.g., walking several blocks or climbing stairs) does not cause undue fatigue, palpitation, dyspnea, or anginal pain. Limiting symptoms may occur with marked exertion. - Class II: Patient has cardiac disease resulting in slight limitation of ordinary physical activity. Patient is comfortable at rest. Ordinary physical activity such as walking more than two blocks or climbing more than one flight of stairs results in limiting symptoms (e.g., fatigue, palpitation, dyspnea, or anginal pain). - Class III: Patient has cardiac disease resulting in marked limitation of physical activity. Patient is comfortable at rest. Less than ordinary physical activity (e.g., walking one to two level blocks or climbing one flight of stairs) causes fatigue, palpitation, dyspnea, or anginal pain. - Class IV: Patient has dyspnea at rest that increases with any physical activity. Patient has cardiac disease resulting in inability to perform any physical activity without discomfort. Symptoms may be present even at rest. If any physical activity is undertaken, discomfort is increased.

Number of Prior Cardiovascular Operations

Indicate whether another cardiac procedure was done (other than CABG and/or Valve procedures).

Status

Indicate the clinical status of the patient prior to entering the operating room: Elective: The patient's cardiac function has been stable in the days or weeks prior to the operation. The procedure could be deferred without increased risk of compromised cardiac outcome. Urgent: Procedure required during same hospitalization in order to minimize chance of further clinical deterioration. Examples include but are not limited to: Worsening, sudden chest pain, CHF, acute myocardial infarction (AMI), anatomy, IABP, unstable angina (USA) with intravenous (IV) nitroglycerin (NTG) or rest angina. Emergent: Patients requiring emergency operations will have ongoing, refractory (difficult, complicated, and/or unmanageable) unrelenting cardiac compromise, with or without hemodynamic instability, and not responsive to any form of therapy except cardiac surgery. An emergency operation is one in which there should be no delay in providing operative intervention. The patient’s clinical status includes any of the following: a. Ischemic dysfunction (any of the following): (1) Ongoing ischemia including rest angina despite maximal medical therapy (medical and/or IABP)); (2) Acute Evolving Myocardial Infarction within 24 hours before surgery; or (3) pulmonary edema requiring intubation. b. Mechanical dysfunction (either of the following): (1) shock with circulatory support; or (2) shock without circulatory support. Emergent Salvage: The patient is undergoing CPR en route to the OR or prior to anesthesia induction.

Resuscitation

Indicate whether the patient required cardiopulmonary resuscitation within one hour before the start of the operative procedure.

Cardiogenic Shock

Indicate whether the patient was, at the time of procedure, in a clinical state of hypoperfusion sustained for greater than 30 minutes, according to either of the following criteria: 1. Systolic BP < 80 and/or Cardiac Index < 1.8 despite maximal treatment; 2. IV inotropes and/or IABP necessary to maintain Systolic BP > 80 and/or CI > 1.8.

Number of Diseased Vessels

Indicate the number of diseased major native coronary vessel systems: LAD system, Circumflex system, and/or Right system with >= 50% narrowing of any vessel preoperatively. NOTE: Left main disease (>=50%) is counted as TWO vessels (LAD and Circumflex, which may include a Ramus Intermedius). For example, left main and RCA would count as three total. Select from the following: None (no significant coronary obstructive disease) One Two Three

Left Main Disease

Indicate whether the patient has Left Main Coronary Disease. Left Main Coronary Disease is present when there is >= 50% compromise of vessel diameter preoperatively.

MI History

Indicate the time period between the last documented myocardial infarction and surgery.

Unstable Angina

There are three principal presentations of unstable angina: 1) rest angina, 2) new -onset (less than 2 months) angina, and 3) increasing angina (in intensity, duration and/or frequency).

Preoperative Intra-aortic Balloon Pump or Inotropes

Indicate whether IABP was inserted preoperatively and/or the patient received IV inotropic agents within 48 hours preceding surgery.

Prior PCI Within 6 Hours of Operation

Indicate whether previous PCI occurred within 6 hours of the current surgical procedure.

Hypertension

Indicate whether the patient has a diagnosis of hypertension, documented by one of the following: a. Documented history of hypertension diagnosed and treated with medication, diet and/or exercise b. Prior documentation of blood pressure >140 mmHg systolic or 90 mmHg diastolic for patients without diabetes or chronic kidney disease, or prior documentation of blood pressure >130 mmHg systolic or 80 mmHg diastolic on at least 2 occasions for patients with diabetes or chronic kidney disease c. Currently on pharmacologic therapy to control hypertension .

Moderate/Severe Tricuspid Insufficiency

Indicate whether there is evidence of Tricuspid valve regurgitation. Enter level of valve function associated with highest risk (i.e., worst performance). Enter the highest level recorded in the chart.

Moderate/Severe Aortic Insufficiency

Indicate whether there is evidence of Aortic valve regurgitation. Enter level of valve function associated with highest risk (i.e., worst performance). Enter the highest level recorded in the chart.

Moderate/Severe Mitral Insufficiency

Indicate whether there is evidence of Mitral valve regurgitation. Enter level of valve function associated with highest risk (i.e., worst performance). Enter the highest level recorded in the chart.

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