Key result
Perioperative MACE occurred in 6.5% of patients after vascular surgery, with SAVS-CRI and VQI-CRI showing slightly better predictive capacity than VSG-CRI or RCRI.
Why the study?
Patients undergoing vascular noncardiac surgery have multiple comorbidities linked to major adverse cardiac events, prompting evaluation of incidence, predictors, outcomes, and predictive risk scores.
Cohort (n=928)
SAVS-CRI and VQI-CRI demonstrated slightly better predictive capacity for perioperative MACE than VSG-CRI or RCRI in patients admitted to intensive care after vascular surgery.
SAVS-CRI and VQI-CRI may modestly improve MACE prediction after vascular surgery; leaves open whether they should replace RCRI.
Introduction. Patients proposed to vascular noncardiac surgery (VS) have several comorbidities associated with major adverse cardiac events (MACE). We evaluated incidence, predictors, and outcomes, and compared different scores to predict MACE after VS. Methods. We included all patients admitted from 2006 to 2013. Perioperative MACE included cardiac arrhythmias, myocardial infarction (MI), cardiogenic pulmonary edema (CPE), acute heart failure (AHF), and cardiac arrest (CA). Lee Revised Cardiac Risk Index (RCRI), Vascular Quality Initiative (VQI-CRI), Vascular Study Group of New England (VSG-CRI), and South African Vascular Surgical (SAVS-CRI) Cardiac Risk Indexes were calculated and analyzed. We performed multivariate logistic regression to assess independent predictors with calculation of odds ratio (OR) and 95% confidence interval (CI). To reduce overfitting, we used leave-one-out cross-validation approach. The Predictive ability of scores was tested using area under receiver operating characteristic curve (AUROC). Results. A total of 928 patients were included. We observed 81 MACE (28 MI, 22 arrhythmias, 10 CPE, 9 AHF, 12 CA) in 60 patients (6.5%): 3.3% in intermediate-risk surgery and 9.8% in high-risk surgery. Previous history of coronary artery disease (OR = 3.2, CI = 1.8-5.7), atrial fibrillation (OR = 5.1, CI = 2.4-11.0), insulin-treated diabetes mellitus (OR = 3.26, CI = 1.51-7.06), mechanical ventilation (OR = 2.75, CI = 1.41-4.63), and heart rate (OR = 1.02, CI = 1.01-1.03) at admission were considered independent risk factors in multivariate analysis. The AUROC of our model was 0.79, compared with RCRI (0.66), VSG-CRI (0.69), VQI-CRI (0.71), and SAVS-CRI (0.73). Conclusions. Observed MACE were within predicted range (1% to 5% after intermediate-risk surgery and >5% after high-risk surgery). SAVS-CRI and VQI-CRI had slightly better predictive capacity than VSG-CRI or RCRI.
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Reis et al. (2019) conducted a cohort in Vascular noncardiac surgery requiring intensive care admission (n=928). Clinical predictors and cardiac risk indexes (RCRI, VQI-CRI, VSG-CRI, SAVS-CRI) was evaluated on Perioperative MACE (cardiac arrhythmias, myocardial infarction, cardiogenic pulmonary edema, acute heart failure, and cardiac arrest). Perioperative MACE occurred in 6.5% of patients after vascular surgery, with SAVS-CRI and VQI-CRI showing slightly better predictive capacity than VSG-CRI or RCRI.
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