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A Vascular Complications Risk (VASCOR) score for patients undergoing invasive cardiac procedures in the
A C Paganin1,2, M G Beghetto1,3, V N Hirakata3
11 Graduate Program in Nursing, Federal University of Rio Grande do Sul, Brazil.
Insights
A new risk score helps predict vascular complications after cardiac catheterization. The score, easily used in practice, identifies patients at higher risk for these common procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Vascular complications frequently occur in catheterization laboratories.
- No validated risk scores currently exist for predicting these complications.
- Arterial access complications pose a significant challenge in interventional cardiology.
Purpose of the Study:
- To develop and validate a risk score for predicting vascular complications.
- To aid clinicians in identifying patients at increased risk for arterial access complications.
- To improve patient safety in catheterization laboratory procedures.
Main Methods:
- Prospective multicenter cohort study.
- Development and validation of a risk score using pre-procedural, intra-procedural, and post-procedural variables.
- Random allocation of patients to derivation (2:1) and validation cohorts.
Main Results:
- The developed score incorporates factors like sheath size, percutaneous coronary intervention, prior complications, anticoagulant use, sex, and age.
- A cutoff score of 3 demonstrated moderate accuracy (sensitivity 0.66, specificity 0.59).
- Patients with a score ≥3 had a nearly threefold increased risk of vascular complications (OR: 2.95).
Conclusions:
- A novel, easily applicable risk score for predicting vascular complications in interventional cardiology was developed.
- The score can assist healthcare providers in daily practice to identify at-risk patients.
- This tool has the potential to enhance patient management and reduce complication rates.
Background:
Vascular complications are still common in the catheterization laboratory setting. However, no risk scores for their prediction have been described. With a view to bridging this gap, the present study sought to develop and validate a score for prediction of vascular complications associated with arterial access in patients undergoing interventional cardiology procedures.
Methods:
This prospective multicenter cohort study included adult patients who underwent cardiac catheterization via the femoral or radial route. The outcomes of interest were: access site hematoma; major and minor bleeding; and retroperitoneal hemorrhage, pseudoaneurysm, or arteriovenous fistula requiring surgical repair. Past medical history as well as pre-procedural, intra-procedural, and post-procedural variables were collected. Patients were randomly allocated to the derivation or validation cohorts at a 2:1 ratio. The following equation constituted the score: (>6F introducer sheath×4.0)+(percutaneous coronary intervention×2.5)+(history of vascular complication after prior interventional cardiology procedure×2.0)+(prior use of warfarin or phenprocoumon×2.0)+(female sex×1.5)+(age⩾60 years×1.5). The maximum score is 13.5 points.
Results:
A score dichotomized at ⩾3 (best cutoff for balancing sensitivity and specificity) was moderately accurate (sensitivity=0.66 (95% confidence interval: 0.59-0.73); specificity=0.59 (95% confidence interval: 0.56-0.61)). Patients with a score ⩾3 were at increased risk of complications (odds ratio: 2.95; 95% confidence interval: 2.22-3.91).
Conclusions:
This study yielded a score that is capable of predicting vascular complications and easily applied in daily practice by providers working in the catheterization laboratory setting.
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