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Prediction of major cardiac events after vascular surgery
Danielle M Gualandro1, Christian Puelacher2, Giovanna LuratiBuse3
1Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
Insights
The Revised Cardiac Risk Index (Lee) and Vascular Study Group (VSG) scores poorly predict cardiac events in vascular surgery patients. Adding preoperative anemia improves the Lee score
Area of Science:
- Cardiology
- Vascular Surgery
- Medical Risk Assessment
Background:
- Predicting perioperative cardiac events is crucial for patient care and surgical risk assessment.
- Existing cardiac risk scores, such as the Revised Cardiac Risk Index (Lee) and the Vascular Study Group of New England Cardiac Risk Index (VSG), are used to evaluate patients undergoing surgery.
Purpose of the Study:
- To evaluate the predictive performance of the Lee and VSG scores for major cardiac events in unselected arterial surgery patients.
- To determine if incorporating additional risk factors enhances the accuracy of these scores.
Main Methods:
- Prospective enrollment of 954 consecutive patients undergoing arterial vascular surgery.
- Calculation of Lee and VSG scores, with construction of receiver operating characteristic curves to compare areas under the curve (AUCs).
- Logistic regression models were used to identify new variables associated with major cardiac events.
Main Results:
- Major cardiac events occurred in 12.6% of patients.
- Both scores underestimated the actual rate of cardiac events.
- The VSG score demonstrated a higher AUC (0.63) than the Lee score (0.58).
- Adding preoperative anemia significantly improved the Lee score's accuracy (AUC to 0.61), but not the VSG score's.
Conclusions:
- The Lee and VSG scores exhibit low accuracy and underestimate the risk of major perioperative cardiac events in unselected vascular surgery patients.
- Preoperative anemia is a significant factor that can improve the accuracy of the Lee score.
- Underestimation of cardiac complications can lead to flawed risk-benefit assessments for surgical procedures.
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.
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