Prediction of major cardiac events after vascular surgery.
- Gualandro DM Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil. Electronic address: danielle.gualandro@incor.usp.br.
- Puelacher C Department of Cardiology, University Hospital Basel, Basel, Switzerland.
- LuratiBuse G Department of Anesthesiology, University Hospital Basel, Basel, Switzerland; Department of Anesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany.
- Llobet GB Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
- Yu PC Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
- Cardozo FA Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
- Glarner N Department of Cardiology, University Hospital Basel, Basel, Switzerland.
- Zimmerli A Department of Cardiology, University Hospital Basel, Basel, Switzerland.
- Espinola J Department of Anesthesiology, Kantonsspital Aarau, Aarau, Switzerland.
- Corbière S Department of Cardiology, University Hospital Basel, Basel, Switzerland.
- Calderaro D Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
- Marques AC Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
- Casella IB Vascular and Endovascular Surgery Division, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil.
- de Luccia N Vascular and Endovascular Surgery Division, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil.
- Oliveira MT Emergency Department, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
- Lampart A Department of Anesthesiology, University Hospital Basel, Basel, Switzerland.
- Bolliger D Department of Anesthesiology, University Hospital Basel, Basel, Switzerland.
- Steiner L Department of Anesthesiology, University Hospital Basel, Basel, Switzerland.
- Seeberger M Department of Anesthesiology, Clinic Hirslanden, Zurich, Switzerland.
- Kindler C Department of Anesthesiology, Kantonsspital Aarau, Aarau, Switzerland.
- Osswald S Department of Cardiology, University Hospital Basel, Basel, Switzerland.
- Gürke L Department of Vascular Surgery, University Hospital Basel, Basel, Switzerland.
- Caramelli B Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
- Mueller C Department of Cardiology, University Hospital Basel, Basel, Switzerland.
- 2017-08-16
Published in:
- Journal of vascular surgery. - 2017
Aged
Area Under Curve
Arteries
Brazil
Chi-Square Distribution
Decision Support Techniques
Female
Heart Diseases
Humans
Logistic Models
Male
Middle Aged
Predictive Value of Tests
Prospective Studies
ROC Curve
Registries
Risk Assessment
Risk Factors
Switzerland
Treatment Outcome
Vascular Surgical Procedures
English
OBJECTIVE
Predicting cardiac events is essential to provide patients with the best medical care and to assess the risk-benefit ratio of surgical procedures. The aim of our study was to evaluate the performance of the Revised Cardiac Risk Index (Lee) and the Vascular Study Group of New England Cardiac Risk Index (VSG) scores for the prediction of major cardiac events in unselected patients undergoing arterial surgery and to determine whether the inclusion of additional risk factors improved their accuracy.
METHODS
The study prospectively enrolled 954 consecutive patients undergoing arterial vascular surgery, and the Lee and VSG scores were calculated. Receiver operating characteristic curves for each cardiac risk score were constructed and the areas under the curve (AUCs) compared. Two logistic regression models were done to determine new variables related to the occurrence of major cardiac events (myocardial infarction, heart failure, arrhythmias, and cardiac arrest).
RESULTS
Cardiac events occurred in 120 (12.6%) patients. Both scores underestimated the rate of cardiac events across all risk strata. The VSG score had AUC of 0.63 (95% confidence interval [CI], 0.58-0.68), which was higher than the AUC of the Lee score (0.58; 95% CI, 0.52-0.63; P = .03). Addition of preoperative anemia significantly improved the accuracy of the Lee score to an AUC of 0.61 (95% CI, 0.58-0.67; P = .002) but not that of the VSG score.
CONCLUSIONS
The Lee and VSG scores have low accuracy and underestimate the risk of major perioperative cardiac events in unselected patients undergoing vascular surgery. The Lee score's accuracy can be increased by adding preoperative anemia. Underestimation of major cardiac complications may lead to incorrect risk-benefit assessments regarding the planned operation.
Predicting cardiac events is essential to provide patients with the best medical care and to assess the risk-benefit ratio of surgical procedures. The aim of our study was to evaluate the performance of the Revised Cardiac Risk Index (Lee) and the Vascular Study Group of New England Cardiac Risk Index (VSG) scores for the prediction of major cardiac events in unselected patients undergoing arterial surgery and to determine whether the inclusion of additional risk factors improved their accuracy.
METHODS
The study prospectively enrolled 954 consecutive patients undergoing arterial vascular surgery, and the Lee and VSG scores were calculated. Receiver operating characteristic curves for each cardiac risk score were constructed and the areas under the curve (AUCs) compared. Two logistic regression models were done to determine new variables related to the occurrence of major cardiac events (myocardial infarction, heart failure, arrhythmias, and cardiac arrest).
RESULTS
Cardiac events occurred in 120 (12.6%) patients. Both scores underestimated the rate of cardiac events across all risk strata. The VSG score had AUC of 0.63 (95% confidence interval [CI], 0.58-0.68), which was higher than the AUC of the Lee score (0.58; 95% CI, 0.52-0.63; P = .03). Addition of preoperative anemia significantly improved the accuracy of the Lee score to an AUC of 0.61 (95% CI, 0.58-0.67; P = .002) but not that of the VSG score.
CONCLUSIONS
The Lee and VSG scores have low accuracy and underestimate the risk of major perioperative cardiac events in unselected patients undergoing vascular surgery. The Lee score's accuracy can be increased by adding preoperative anemia. Underestimation of major cardiac complications may lead to incorrect risk-benefit assessments regarding the planned operation.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1016/j.jvs.2017.05.100
- PMID 28807383
- Persistent URL
- https://folia.unifr.ch/global/documents/299380
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