Risk Scores

Question 1

What is the STS score and name ten components

Answer 1

STS Score: Predicts mortality and morbidity for a given cardiac procedure.

-Patient Age
-Race
-Gender
-Type of surgery
-Renal function/On IHD
-WBC, Plt, Hb
-Other Cardiac Lesions: CAD/Valvular disease
-Presentation: Arrest, VAD/ECMO, IABP
-LV function
-Urgency of procedure

Question 2

What is the EURO score and what are the components?

Answer 2

EURO Score: Predicts post operative mortality for cardiac surgery

Just name same as STS (lots of overlap)

Question 3

What is the GRACE score and what are the components?

Answer 3

GRACE Score: Estimatesin hospital mortality for patients with ACS. > 140 ( > 3%). < 108 is <1%

Age
HR
SBP
Cr
ECG changes
Troponin elevation
Arrest on presentation
Kilip class

Question 4

What is the TIMI score and what are the components?

Answer 4

TIMI: Estimates 14day mortality/morbidity for NSTEACS

Age > 65
Established CVD
3 CV RFs
ECG changes
Troponin elevation
On ASA in past 7 days
Recurrent CP in past 24h

> 2 high risk, multiply score by 4.5 to get % risk

Question 5

What is the DAPT score and what are the components?

Answer 5

DAPT score to decide whether benefits of extending DAPT outweigh the risks. A score of 2 or greater indicates benefit to extending

-Age: >75, <65, 66-75 (older, more bleeding risk)
-Smoking
-Diabetes
-ACS on presentation
-LM stent
-Multivessel stent
-Stent diameter < 3 mm
-Vein graft stent
-LVEF < 30%
-Paclitaxel eluting stent

Question 6

What is the Precise DAPT score and what does it predict?

Answer 6

Predicts the risk of bleeding on DAPT

Age
Creatinine Clearance
Prior Bleed
WBC
Hemoglobin

Question 7

**What is the SYNTAX score and what does it predict?

Answer 7

Syntax Score: Provides anatomic and prognostic variables to create accurate mortalite estimates and aids in deciding between PCI and CABG for patients with multivessel CAD

Coronary Dominance
Segments that are diseased
CTO
Trifurcation
Bifurcation
Ostial disease
Severe Tortuosity
Length > 20mm
Heavy Calcification
Thrombus

Question 8

What is the HASBLED score and what does it signify?

Answer 8

HASBLED: Estimates risk of major bleeding for patients on anticoagulation to assess risk-benefit in Afib care

Hypertension
Abnormal Liver (Bili > 2x, AST > 3x) /Renal function (Cr > 200)
Stroke/TIA history
Bleeding in past
Labile INRs (<60% in therapeutic range)
Elderly > 65 years old
Drugs that promote bleeding/toxins/ETOH use

Question 9

What is the CARPREG 2 score and what is it used for?

Answer 9

Predicting maternal risk in Pregnancy

Late antenatal visit (1)
No prior cardiac intervention (1)
AVA < 1.5 (2)
MVA < 2 (2)
LVOTO > 50mmhg (2)
PAH > 50mmhg (2)
NYHA III/IV / Decompensated HF (3)
Coronary Artery Disease (2)
Prior Cardiac Events or Arrhyhtmias (3)
Mechanical Valves (3)
LV dysfunction < 55% (2)
High risk Aortopathy (2)

Risk of Primary Cardiac Event:
-0 to 1: 5%
-2: 10%
-3: 15%
-4: 20%
>4: 40%

Question 10

What are the components of the FRS?

Answer 10

Age
Gender
Smoking
Blood pressure (on treatment or not)
Total Cholesterol
HDL Cholesterol

Question 11

What are the components of the Interheart score? (11)

Answer 11

Age
Sex
Family history
Diabetes
Hypertension
Psychosocial Stress Levels
Smoking (Personal and Second hand smoke)
Diet (Salty food, fruit and vegetable intake, meat, deep fried)
Exercise
Lipid panel
Waist and Abdominal Circumference

Question 12

What is the RCRI score?

Answer 12

Risk of Cardiac Events

CAD
HF
CVD
Cr > 176
DM on Insulin
High risk OR (Intrathoracic/Intraperiotoneal/Vascular)

> 2 -> High risk (9%)

Question 13

Describe SCAI staging for Cardiogenic Shock:

Answer 13

A: At Risk for Cardiogenic Shock (At Risk)

B: Hypotensive and Tachycardic but no evidence of Hypoperfusion (Beginning)
-Normal Lactate

C: Hypoperfusion but not deteriorating (Classic)
-Lactate > 2, UO < 30, Increasing Cr, LFTs
-CI < 2.2, PCWP > 15, RAP/PCWP > 0.8, PAPI (Pulmonary Artery Pulsatility Index) < 1.85

D: Hypoperfusion and Deteriorating but not refractory Shock (Deteriorating)
-Stage C and deteriorating (Multiple pressors, MCS)

E: Refractory Shock (Extremis)
-Lactate > 5, PH < 7.2
-No SBP without resuscitation, Recurrent Arrest, maximal support

Question 14

Describe the INTERMACS Profile

Answer 14

1: Crash and Burn

2: Deteriorating on Inotropes

3: Inotrope Dependent

4: Resting symptoms

5: Exertion Intolerant

6: Exertion Tolerant

7: Advanced NYHA III

Question 15

Definition of Cardiogenic Shock (As per the SHOCK trial) ?

Answer 15

-SBP < 90mmhg (or MAP 30mmhg below baseline)

-CI < 1.8 without support (or 2.2 with support)

-LVEDP > 15mmhg

Question 16

What are diagnostic criteria for Myocarditis? (Dallas, CCS)

Answer 16

Dallas (Only definitive): Presence of inflammatory infiltrate with myocyte necrosis not in keeping with pattern of Coronary disease.

CCS (4 major elements):
i) Symptoms consistent with myocardial damage
ii) evidence of myocardial injury without epicardial coronary cause
iii) hyperemia edema or irreversible damage on CMR
iv) presence of inflammatory cells or positive viral genome on EMB

Question 17

Name the components of the Schwartz score?

Answer 17

QTc > 480 msec (3)
QTc 460-480 msec (2)
QTc 450-460 msec (1)
QTc 4 min after exercise > 480 msec (1)
Torsades (2)
T wave alternans (1)
T wave notching on three leads (1)
Syncope with exercise (2)
Syncope at rest (1)
Family member with LQTS (1)
SCD < 30 (0.5)

> 3.5 -> high probability

Question 18

Describe the Risk of Contrast Nephrotoxicity post PCI

Answer 18

-Hypotension (5)

-IABP (5)

-Heart Failure (5)

• > 75 years (4)

-Anemia (3)

Diabetes (3)

-Each 100 cc of contrast (1)

-CrC1 > 130 (4)

Question 19

What are 7 independent variables identified in the CARDSHOCK for short term predictors for mortality in Cardiogenic shock?

Answer 19

-Age > 75
-LVEF < 40%
-ACS etiology
-Previous MI or CABG
-Increasing Lactate levels
-eGFR < 30
-Confusion

Additional from AHA 2017: Number of Vasopressors, Anoxic brain injury, MR, SBP, TIMI Flow, RV function, Low PAPI (PA Pulse Pressure / RAP)