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Preoperative cardiac risk index predicts long-term mortality and health status
Sanne E Hoeks1, Wilma J M Scholte op Reimer, Yvette R B M van Gestel
1Department of Anaesthesiology, Erasmus Medical Center, Rotterdam, the Netherlands.
Insights
The Lee Risk Index effectively predicts long-term mortality and health status in peripheral arterial disease patients after vascular surgery. This score aids in assessing risks beyond immediate post-operative outcomes.
Area of Science:
- Cardiovascular Surgery
- Vascular Medicine
- Outcomes Research
Background:
- Peripheral arterial disease (PAD) patients undergoing vascular surgery face significant risks of late cardiovascular events.
- The Lee Risk Index is a common tool for assessing perioperative cardiac risk based on six factors.
Purpose of the Study:
- To evaluate the predictive capability of the Lee Risk Index for late mortality.
- To assess the Lee Risk Index's ability to predict long-term health status in PAD patients post-vascular surgery.
Main Methods:
- A cohort of 711 PAD patients undergoing vascular surgery was studied across 11 Dutch hospitals.
- The Lee Risk Index was calculated preoperatively; 3-year follow-up data included mortality and Peripheral Artery Questionnaire (PAQ) scores for health status.
Main Results:
- The Lee Risk Index independently predicted late mortality (HRs ranging from 2.1 to 3.2) and impaired health status (ORs ranging from 2.0 to 3.2).
- Key predictors for mortality included cerebrovascular disease, insulin-dependent diabetes, and renal insufficiency.
- Prognostic factors for impaired health status comprised ischemic heart disease, heart failure, cerebrovascular disease, insulin-dependent diabetes, and renal insufficiency.
Conclusions:
- The preoperative Lee Risk Index is a valuable prognostic indicator for both in-hospital outcomes and long-term results.
- It accurately predicts late mortality and impaired health status in patients with peripheral arterial disease.
Objectives:
Peripheral arterial disease patients undergoing vascular surgery are known to be at risk for the occurrence of (late) cardiovascular events. Before surgery, the perioperative cardiac risk is commonly assessed using the Lee Risk Index score, a combination of 6 cardiac risk factors. This study assessed the predictive value of the Lee Risk Index for late mortality and long-term health status in patients after vascular surgery.
Methods:
Between May and December 2004, data on 711 consecutive peripheral arterial disease patients undergoing vascular surgery were collected from 11 hospitals in the Netherlands. Before surgery, the Lee Risk Index was assessed in all patients. At 3-year follow-up, 149 patients died (21%) and the disease-specific Peripheral Artery Questionnaire (PAQ) was completed in 84% (n=465) of the survivors. Impaired health status according to the PAQ was defined by the lowest tertile of the PAQ summary score. Multivariable regression analyses were performed to investigate the prognostic ability of the Lee Index for mortality and impaired health status at 3-year follow-up.
Results:
The Lee Risk Index proved to be an independent prognostic factor for both late mortality (1 risk factor hazard ratio (HR)=2.1; 95% confidence interval [CI], 1.2-3.6; 2 risk factors HR=2.4; 95% CI, 1.4-4.0 and >or=3 risk factors HR=3.2; 95% CI, 1.7-6.2) and impaired health status at 3-year follow-up (1 risk factor odds ratio [OR]=2.0; 95% CI, 1.1-3.5; 2 risk factors OR=2.9; 95% CI, 1.6-5.2 and >or=3 risk factors OR=3.2; 95% CI, 1.3-7.5). The predominant contributing factors associated with late mortality were cerebrovascular disease, insulin-dependent diabetes, and renal insufficiency. For impaired health status, ischemic heart disease, heart failure, cerebrovascular disease, insulin-dependent diabetes, and renal insufficiency were the prognostic factors.
Conclusions:
The preoperative Lee Risk Index is not only an important prognostic factor for in-hospital outcome but also for late mortality and impaired health status in patients with peripheral arterial disease.
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