Text

Number

Text

0

1

2

3

4

0 No angina

1 Ordinary physical activity such as walking or climbing stairs does not cause angina. Angina may occur with strenuous, rapid or prolonged exertion.

2 There is slight limitation of ordinary activity, angina may occur on walking or climbing stairs rapidly, walking up hill or walking after meals, in the cold, wind or under emotional stress or climbing more than one flight of stairs under normal conditions.

3 There is marked limitation of ordinary physical activity, angina may occur after walking 100 yards or climbing one flight of stairs under normal conditions at a normal pace

4 Inability to perform any physical activity without discomfort. Angina may occur at rest.

Number

1

2

3

4

1 = Patients with cardiac disease but without limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation or dyspnoea.

Asymptomatic patients should be classified as Class 1

2 = cardiac disease resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpitations or dyspnoea.

3 = cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary physical activity results in fatigue, palpitations or dyspnoea.

4 = cardiac disease resulting in an inability to conduct any physical activity without discomfort. Symptoms of cardiac failure may be present even at rest. If any physical activity is undertaken discomfort is increased.

Number

0 None

1 One

2 Two

3 Three

… etc…

99 Unknown

Number of previous Q-wave myocardial infarctions

Number

0 Not applicable

1 < 6 hours before operation

2 6-24 hours

3 1-30 days

4 >30 days

A transmural myocardial infarct represented by new Q waves in two or more contiguous leads on the ECG.

Number

0 No previous MI or more than 90 days ago

1 Yes MI within 90 days

MI within last 90 days. Do not alter previous question. Essential for historical data

Number

0 No

1 Until operation

2 Within 1 week of operation

Option 2 counts as Unstable Angina for Euroscore

Number

0 No

1 Yes

9 Unknown

Enter any previous intervention

Number

0 No

1 Within 24 hours of operation

2 > 24 hours, op on same admission

Any failed cardiological intervention (coronary or valvular) necessitating immediate surgery or surgery during the same admission

Number

0 No

1 Diet

2 Oral therapy

3 Insulin

Any history of diabetes regardless of duration or treatment.

Latent diabetes of pregnancy excluded

Number

0 No

1 Yes

9 Unknown

A history of blood pressure greater than 140/90mmHg on two occasions, or lower if on medication

Number

0 Never smoked

1 Ex smoker

2 Current smoker

Patients who have smoked within one month of surgery should be considered to be current smokers.

Number

0 No

1 Functioning transplant

2 Creatinine > 200µmol/l

3 Acute renal failure: dialysis

4 Chronic renal failure: dialysis

0 No history of renal disease and creatinine < 200µmol/l on admission

1 Functioning renal transplant, irrespective of creatinine

2 Creatinine > 200µmol/l at the time of surgery

3 Renal failure within 6 weeks of surgery necessitating any form of dialysis up to the time of surgery

4 Chronic renal failure on regular dialysis

Number

Number

0 No

1 Peripheral vascular disease

1 Any one of:

* History or evidence of aneurysm or occlusive peripheral vascular disease.

* Aortic aneurysm

* Previous aortoiliac or peripheral vascular surgery

* Reduced or absent peripheral pulses and/or angiographic stenosis of more than 50%

Number

0 No

1 COAD/emphysema

2 Asthma

0 Tick if no history of pulmonary disease

1 Patient requires medication (inhalers, aminophylline or steroids) for chronic pulmonary disease or FEV1 less than 75% predicted value.

Venous pO2 < 60mmHg, pCO2 > 50mmHg

2 Intermittent or allergic reversible airways disease treated with bronchodilators or steroids

Number

1 Good

2 Fair

3 Poor

Enter

GOOD (>50%)

FAIR (30-50%) or

POOR (<30%) if known

Number

0 No

1 Yes

Any inotropic agents, excluding renal dose dopamine at the time of starting surgery.

Number

0 No

1 Yes

The presence of a preoperative intra-aortic balloon pump for haemodynamic reasons.

Do NOT include IABP’s inserted prophylactically just prior to surgery because these represent post-operative support.

Number

1 Elective

2 Urgent

3 Emergency

4 Salvage

1 Routine admission from the waiting list. The procedure can be deferred without risk

2 Patients who have not been scheduled for routine admission from the waiting list but who require surgery on the current admission for medical reasons. They cannot be sent home without surgery

3 Unscheduled patients with ongoing refractory cardiac compromise. There should be no delay in surgical intervention irrespective of the time of day

4 Patients requiring CPR en-route to the operating theatre or prior to anaesthetic induction. CPR following anaesthetic induction should not be included

Number

1 First operation

2 Second operation

3 Third operation

etc…

Enter option designating number of cardiac surgical procedures including current procedure.

Number

dd/mm/yyyy

dd/mm/yyyy

Date

0 - 23

99 = unknown

Hour on 24 hour clock, that patient is brought to the anaesthetic room.

e.g. 1.45 pm = 13

Number

xx.x

Time spent in theatre in hours. (I.e. interval between arrival in anaesthetic room and leaving theatre after surgery)

Number

0 No

1 Yes

9 Unknown

If bypass used for part or all of the procedure tick “yes”

Number

0 unknown

1 no

2 yes

Pulmonary artery catheter present while patient is in theatre.

Number

xxx

Mean pulmonary artery pressure (mmHg.) after induction of anaesthesia and prior to commencing cardiopulmonary bypass.

1 CABG only

2 CABG + valve

3 CABG + valve + other (see below)

4 CABG + other (see below)

5 Valve replacement/repair

6 Valve + other (see below)

7 Congenital

8 Other (see below)

Tick as appropriate

This provides rapid grouping for procedure based reports

Number

1 LV aneurysmectomy

2 Acquired VSD

3 Atrial myxoma

4 Pulmonary embolectomy

5 Cardiac transplant

6 Pulmonary transplant

7 Cardiac trauma

8 Epicardial pacemaker

9 Pericardiectomy

Option 2 counts as post-infarct VSD for Euroscore

Number

1 Aortic or peripheral vascular

2 Carotid endarterectomy

3 Other thoracic

Number

Please enter appropriate number

Number

minutes

Enter time in minutes.

Cumulative bypass time irrespective of the number of times on bypass.

Number

xx.x

0 missing

Pre-operative Haemoglobin concentration (g/dl)

Number

0 None, missing = 999

Total number of Units of blood used intra-operatively and post-operatively.

Number

xx.x

0 missing

Haemoglobin concentration (g/dl) prior to discharge.

Number

minutes

Enter time in minutes

Number

1 Consultant

2 Staff grade/clinical assistant

3 Trainee + consultant

4 Trainee

Indicates grade of operating surgeon.

Number

0 unknown

1 Consultant

2 SpR year 3 or more

3 SpR year 1 or 2

4 Other

5 post CCST

Grade of principal anaesthetist responsible for the anaesthetic.

Number

Numeric identifier for the principal anaesthetist. If non consultant use 999.

0 unknown

1 Consultant

2 SpR year 3 or more

3 SpR year 1 or 2

4 Other

5 post CCST

Grade of assistant anaesthetist

Number

0 No

1 Inotropes

2 Intra-aortic balloon pump

3 Ventricular assist device(s)

Can have multiple values

1 On leaving theatre, or commenced in the ITU

(exclude < 3 ug/kg/min Dopamine)

2 Tick if used at any stage in the post operative course

text

0 None

1 For bleeding/tamponade

2 Other |(exclusive of sternal resuturing)

1 Reoperation for bleeding related reasons

2 Exploration for other reasons e.g. cardiac arrest, additional grafting etc.

Number

Number of hours if less than 24

Enter time frame for extubation

If option 4 is selected, you MUST enter the next variable also

days

If ventilated for more than 24 hours, enter number of days

Number

0 None

1 Re-intubation and ventilation

2 Full Tracheostomy

3 Pulmonary embolism, 4 Other

2 Either surgical or percutaneous

3 Documented pulmonary embolism

0 None

1 Transient stroke/neurological deficit

2 Permanent stroke,

3 Other

1 Neurological deficit which has recovered fully by the time of discharge from hospital.

2 Persisting neurological deficit at time of discharge from hospital

Number

0 None

1 Post op creatinine >200 ?mol/l

2 New dialysis/ filtration required

Number

days

Enter time in nights as appropriate

Number

0 No

1 Yes

Yes or No

Number

1 Alive

2 Dead

Alive or Dead

Number

dd/mm/yyyy

Enter day / month / year. If alive at discharge, enter date of discharge. If died before discharge, enter date of death.

Date

days

Length of post-op stay in days (Automatically calculated)

Number

dd/mm/yyyy

If survived to discharge but died later, enter date of death.

Date

days

Day post-op that patient died

Number