Danielle M Gualandro1, Christian Puelacher2, Giovanna LuratiBuse3, Gisela B Llobet4, Pai C Yu4, Francisco A Cardozo4, Noemi Glarner2, Andres Zimmerli2, Jaqueline Espinola5, Sydney Corbière2, Daniela Calderaro4, Andre C Marques4, Ivan B Casella6, Nelson de Luccia6, Mucio T Oliveira7, Andreas Lampart8, Daniel Bolliger8, Luzius Steiner8, Manfred Seeberger9, Christoph Kindler5, Stefan Osswald2, Lorenz Gürke10, Bruno Caramelli4, Christian Mueller2. 1. 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. 2. Department of Cardiology, University Hospital Basel, Basel, Switzerland. 3. Department of Anesthesiology, University Hospital Basel, Basel, Switzerland; Department of Anesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany. 4. Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil. 5. Department of Anesthesiology, Kantonsspital Aarau, Aarau, Switzerland. 6. Vascular and Endovascular Surgery Division, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil. 7. Emergency Department, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil. 8. Department of Anesthesiology, University Hospital Basel, Basel, Switzerland. 9. Department of Anesthesiology, Clinic Hirslanden, Zurich, Switzerland. 10. Department of Vascular Surgery, University Hospital Basel, Basel, Switzerland.
Abstract
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.
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.
Authors: Lisette M Vernooij; Wilton A van Klei; Karel Gm Moons; Toshihiko Takada; Judith van Waes; Johanna Aag Damen Journal: Cochrane Database Syst Rev Date: 2021-12-21
Authors: Lorraine Sazgary; Christian Puelacher; Giovanna Lurati Buse; Noemi Glarner; Andreas Lampart; Daniel Bolliger; Luzius Steiner; Lorenz Gürke; Thomas Wolff; Edin Mujagic; Stefan Schaeren; Didier Lardinois; Jacqueline Espinola; Christoph Kindler; Angelika Hammerer-Lercher; Ivo Strebel; Karin Wildi; Reka Hidvegi; Johanna Gueckel; Christina Hollenstein; Tobias Breidthardt; Katharina Rentsch; Andreas Buser; Danielle M Gualandro; Christian Mueller Journal: Eur Heart J Acute Cardiovasc Care Date: 2020-10-14