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Cardiac risk stratification for high-risk vascular surgery
C Bartels1, J F Bechtel, V Hossmann
1Department of Vascular Surgery, Krankenhaus Porz am Rhein, Teaching Hospital, University of Cologne, Germany.
Insights
A cardiac risk stratification protocol, similar to ACC/AHA guidelines, proved safe and economical for high-risk vascular surgery patients. This strategy effectively assessed cardiac risk, leading to excellent clinical outcomes and reduced mortality.
Area of Science:
- Cardiology
- Vascular Surgery
- Risk Assessment
Background:
- The optimal strategy for cardiac risk assessment prior to high-risk vascular surgery is debated.
- This study evaluated a cardiac risk stratification protocol in patients undergoing high-risk vascular surgery.
- The protocol aligns with the American College of Cardiology/American Heart Association (ACC/AHA) guidelines.
Purpose of the Study:
- To evaluate the clinical outcome and cost-effectiveness of a cardiac risk stratification protocol for patients undergoing high-risk vascular surgery.
- To assess the safety and efficacy of a preoperative cardiac evaluation strategy comparable to ACC/AHA guidelines.
Main Methods:
- A prospective study of 203 patients undergoing aortic surgery.
- Patients were stratified into low, intermediate, and high cardiac risk groups based on clinical predictors.
- Functional capacity was assessed using metabolic equivalents (METs) from treadmill exercise and daily activities.
Main Results:
- Cardiac risk stratification identified 101 low-risk, 79 intermediate-risk, and 23 high-risk patients.
- Further cardiac evaluation was indicated for intermediate-risk patients with < 5 METs and all high-risk patients.
- Overall hospital mortality was 3.5%, with cardiac mortality at 1% and cardiac morbidity at 12.4%.
Conclusions:
- A cardiac risk stratification protocol similar to ACC/AHA guidelines yielded excellent clinical outcomes in high-risk vascular surgery patients.
- This approach represents a safe and cost-effective strategy for preoperative cardiac evaluation.
- The protocol demonstrated successful risk stratification and management, contributing to favorable patient outcomes.
Background:
The best strategy for cardiac risk assessment before high-risk vascular surgery remains controversial. A cardiac risk stratification protocol was evaluated in patients undergoing high-risk vascular surgery. Our investigation paralleled the elaboration of the American College of Cardiology/ American Heart Association (ACC/AHA) Guidelines for Perioperative Cardiovascular Evaluation for Noncardiac Surgery and is highly comparable to the proposed guidelines.
Methods And Results:
A cardiac risk stratification protocol was evaluated prospectively in 203 patients scheduled for aortic surgery. Key points of the study were cardiac mortality/morbidity and cost-effectiveness. Patients were stratified into low (n = 101), intermediate (n = 79), and high (n = 23) cardiac risk after clinical predictors. After stratification, the degree of estimated functional capacity assessed by treadmill exercise and daily living activities and expressed by metabolic equivalents (METs) was critical for further cardiac evaluation. In intermediate-risk patients with an estimated functional capacity < 5 METs and in all high-risk patients, noninvasive cardiac testing and/or subsequent medical care were performed. Noninvasive testing was considered necessary in 41 patients, coronary angiography in 7, and myocardial revascularization in 1. Overall hospital mortality was 3.5%. Cardiac mortality and morbidity were 1% and 12.4%, respectively.
Conclusions:
Cardiac risk stratification for high-risk vascular surgery patients, according to a protocol similar to the ACC/AHA Guidelines for Cardiovascular Evaluation for Noncardiac Surgery, demonstrated excellent clinical outcome. This approach appears to be a safe and economical strategy for preoperative cardiac evaluation.