Potential New Approaches in Predicting Adverse Cardiac Events One Month after Major Vascular Surgery

Abstract

Objective: The aim of our study was to find the best model with sufficient power to improve the risk stratification in major vascular surgery patients during the first 30 days after this procedure. The discriminatory power of 4 biomarkers (troponin I [TnI], N-terminal prohormone of brain natriuretic peptide [NT-proBNP], creatine kinase-MB isoenzyme [CK-MB], high-sensitivity C-reactive protein [hs-CRP]) was tested as well as 2 risk assessment models and 13 different combinations of them. Subjects and Methods: The study included 122 patients (77% men, 23% women) with an average age of 67.03 ± 4.5 years. An aortobifemoral bypass was performed in 6.56% of the patients, a femoropopliteal bypass in 18.85%, and 49.18% received open surgical reconstruction of the carotid arteries. A total of 25.41% of the patients were given an aortobi-iliac bypass. Results: During the first 30 days, 13 patients (10.7%) had 17 cardiac complications. The most common complication was the new onset of atrial fibrillation (35.3%). During the first 10 days, 10 patients had 1 complication and 2 patients had 2 cardiac events, while 1 patient had 3 complications. By comparing combinations of scores and markers, it was shown that revised cardiac risk index (RCRI) + Vascular Portsmouth Physiological and Operative Severity Score (V-POSSUM) + hsTnI and RCRI + V-POSSUM + hsTnI + NT-proBNP with 100% sensitivity, > 80% specificity had the best discriminatory ability (AUC 0.924 and 0.933, respectively; p < 0.001 for both models) for cardiac complications during the 30 days after surgery. Conclusion: Combinations of traditional preoperative risk factors and scores can enhance the assessment of major adverse cardiac events (MACE) in patients preparing for large vascular surgery. Using only one risk score in these patients seems to be underperforming in preoperative risk assessment.

Predictive potential of biomarkers and risk scores for major adverse cardiac events in elderly patients undergoing major elective vascular surgery

“…Adverse cardiac events are responsible for nearly half of perioperative deaths [25]. The lack of a generally accepted definition of MACE [14], differences in high-sensitivity biomarker assays [26], and consequent changes in the definitions of individual cardiac events [27] are several problems in analyzing and comparing study results. The term MACE was established to assess the safety and effectiveness of various cardiac therapeutic methods [28] and has long referred to the manifestations of the atherosclerotic process in the coronary and cerebral vasculature [29].…”

“…Cardiac biomarkers are hallmarks of various pathophysiological mechanisms, such as inflammation, ischemia, neurohormonal activation, plaque instability or rupture, platelet activation, and myocardial wall stretch and stress [14,15]. The latter can be established with preoperative assessment of B-type natriuretic peptide (BNP) or N-terminal fragment of pro-BNP (NT-proBNP), which is recommended according to the Canadian Cardiovascular Society (CCS) in patients 65 years or older [16].…”

The effect of cognitive dysfunction on mid- and long-term mortality after vascular surgery

“…), outcomes, the incidence and severity of postoperative complications (major cerebrovascular or neurological event; acute or chronic heart failure defined as pulmonary oedema, atrial fibrillation, arrhythmias, cyanosis, metabolic disorders, need for inotropes, respiratory failure; infection; acute renal failure/need for renal replacement therapy; length of mechanical ventilation; length of ICU and in-hospital stay and in-hospital mortality rate). The American Society of Anesthesiologists risk score (ASA score) [9] and the Vascular Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (vascular POSSUM) [10][11][12][13] were also calculated. The vascular-POSSUM consists of two parts, a physiological score and an operative score.…”

The impact of cognitive dysfunction on mid- and long-term mortality after vascular surgery

“…), outcomes, incidence and quality of postoperative complications (major cerebrovascular or neurological event; acute or chronic heart failure de ned as pulmonary edema, atrial brillation, arrhythmias, cyanosis, metabolic disorders, need for inotropes, respiratory failure; infection; acute renal failure /need for renal replacement therapy/; length of mechanical ventilation; length of ICU and in-hospital stay and in-hospital mortality). The American Society of Anesthesiologist risk score (ASA score) [9], and the Vascular Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (Vascular POSSUM) [10][11][12][13] were calculated, too. The vascular-POSSUM consists of two parts, a physiological and an operative score.…”