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Major Cardiac Events in Patients Admitted to Intensive Care After Vascular Noncardiac Surgery: A Retrospective Cohort

Pedro Videira Reis1,2, Ana Isabel Lopes1, Diana Leite1

  • 11 São João Hospital Centre, Porto, Portugal.

Seminars in Cardiothoracic and Vascular Anesthesia
|January 26, 2019
PubMed

Insights

This study identified key predictors of major adverse cardiac events (MACE) in vascular noncardiac surgery patients. The South African Vascular Surgical (SAVS-CRI) and Vascular Quality Initiative (VQI-CRI) scores showed better prediction accuracy for MACE.

Area of Science:

  • Cardiology
  • Vascular Surgery
  • Medical Informatics

Background:

  • Patients undergoing vascular noncardiac surgery (VS) often have comorbidities that increase the risk of major adverse cardiac events (MACE).
  • Accurate prediction of MACE is crucial for patient management and risk stratification in VS.
  • Several cardiac risk indexes exist, but their comparative performance in VS is not fully established.

Purpose of the Study:

  • To evaluate the incidence, independent predictors, and outcomes of MACE in patients undergoing VS.
  • To compare the predictive accuracy of different cardiac risk scores for MACE after VS.

Main Methods:

  • A retrospective analysis of 928 patients undergoing VS between 2006 and 2013.
  • Perioperative MACE included cardiac arrhythmias, myocardial infarction (MI), cardiogenic pulmonary edema (CPE), acute heart failure (AHF), and cardiac arrest (CA).
  • The Lee Revised Cardiac Risk Index (RCRI), Vascular Quality Initiative-Cardiac Risk Index (VQI-CRI), Vascular Study Group of New England-Cardiac Risk Index (VSG-CRI), and South African Vascular Surgical-Cardiac Risk Index (SAVS-CRI) were calculated and compared using area under the receiver operating characteristic curve (AUROC).

Main Results:

  • The overall MACE incidence was 6.5% (81 events in 60 patients), with higher rates in high-risk surgery (9.8%) compared to intermediate-risk surgery (3.3%).
  • Independent predictors of MACE included prior coronary artery disease, atrial fibrillation, insulin-treated diabetes mellitus, need for mechanical ventilation, and admission heart rate.
  • The developed multivariate model achieved an AUROC of 0.79, outperforming RCRI (0.66), VSG-CRI (0.69), VQI-CRI (0.71), and SAVS-CRI (0.73).

Conclusions:

  • Observed MACE rates were consistent with predicted ranges for intermediate and high-risk surgeries.
  • The SAVS-CRI and VQI-CRI demonstrated slightly superior predictive capacity for MACE compared to VSG-CRI and RCRI.
  • The study highlights the importance of identifying specific patient factors and utilizing validated risk scores for MACE prediction in vascular surgery.

Keywords:
cardiac arrestcardiac arrhythmiaheart failureintensive care unitmyocardial infarctionpulmonary edemavascular surgery

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