Scoring Systems / Risk Tools

Question 1

6 Month Mortality risk in ACS (1)

Answer 1

1. GRACE score

Consists of (dont memorise)
1. Age

2. Heart Rate
3. Blood Pressure
4. Cardiac Killip Class
5. Renal Function - serum creatinine
6. Arrest on presentation?
7. ECG findings
8. Troponins

calculated online - don’t memorise but good to see here

Question 2

Interpret GRACE scores (6)

Answer 2

1. 1.5% or less = lowest risk
2. 1.5 - 3% = Low
3. 3.0 - 6.0% = intermediate
4. 6.0 - 9.0% = high
5. above 9% = highest
6. If high GRACE following an NSTEMI - PCI electively wihtin a couple of days

Question 3

Killip Classification - 30 day mortality following MI

Answer 3

1. Class 1 - no clinical HF Sxs = 6%
2. Class 2 - Lung crackles, S3 = 17%
3. Class 3 - Frank Pul Oedema = 38%
4. Class 4 - Cardiogenic Shock = 81%

% = % mortality in 30 days (prognostic)

Question 4

CHA2DS2-Vasc (7)

Answer 4

1. CHF - 1
2. HTN - 1
3. Age >75 - 2
   Age 65 - 74 - 1
4. DM - 1
5. Prior Stroke, TIA, VTE - 2
6. Vascular Disease - 1
7. Sex Female - 1

Score 0 - no Tx
Score 1 - offer Tx to males
Score 2 or more - offer Tx

Question 5

Bleeding Risk - Components of ORBIT score (5)

Answer 5

1. Hb <130 (men), <12 (women) - 2 points
2. Age >74 - 1 point
3. Bleeding Hx (GI, Brain) - 2 Points
4. Renal Impairment eGFR <60 - 1 point
5. On Antiplatelets - 1 Point

Question 6

Interpretation of ORBIT score (3)

Answer 6

1. 0-2 = Low risk = 2.4 bleeds /100 patient years
2. 3 = Intermediate risk = 4.7/100
3. 4-7 = High risk = 8.1/100

Question 7

Classification of HF - NYHA (4)

Answer 7

NYHA Class 1:
1. No Sxs, no limitation

NYHA Class 2:
2. Mild sxs, SLight limitation from fatigue, palps, dyspnoea on exertion

NYHA Class 3:
3. Moderate Sxs, Marked limitation on exertion

NYHA Class 4:
4. Severe Sxs, Sxs at rest, unable to do any exertion without Sxs limiting ability