Prediction of cardiac risk before abdominal aortic reconstruction: Comparison of a revised Goldman Cardiac Risk Index and radioisotope ejection fraction

Karkos, Christos D.; Thomson, G. J. L.; Hughes, Robert; Hollis, Sally; Hill, Jonathan; Mukhopadhyay, Umasankar S.

doi:10.1067/mva.2002.121982

Cited by 17 publications

(10 citation statements)

References 38 publications

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“…Numerous attempts to predict cardiac risk before noncardiac [1][2][3] or vascular surgery [4][5][6][7][8][9][10] have been conducted. Currently, the most commonly used model is the Revised Cardiac Risk Index (RCRI), which stratifies patients into low-, intermediate-, and high-risk groups before elective, noncardiac surgery.…”

mentioning

confidence: 99%

The Vascular Study Group of New England Cardiac Risk Index (VSG-CRI) predicts cardiac complications more accurately than the Revised Cardiac Risk Index in vascular surgery patients

Bertges

Goodney

Zhao

et al. 2010

Journal of Vascular Surgery

201

154

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mentioning

confidence: 99%

The Vascular Study Group of New England Cardiac Risk Index (VSG-CRI) predicts cardiac complications more accurately than the Revised Cardiac Risk Index in vascular surgery patients

Bertges

Goodney

Zhao

et al. 2010

Journal of Vascular Surgery

201

154

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“…5 For example, congestive heart failure (CHF) is an important predictor for postoperative cardiac events in patients undergoing vascular surgery. 6 Although prior studies have investigated the association between left ventricular function and postoperative adverse cardiac outcomes in this surgical cohort, evaluation of the prognostic value of right ventricular function has been lacking. 7,8 Right ventricular (RV) function may be an overlooked contributor to perioperative morbidity and mortality.…”

mentioning

confidence: 99%

Preexisting Right Ventricular Dysfunction Is Associated With Higher Postoperative Cardiac Complications and Longer Hospital Stay in High-Risk Patients Undergoing Nonemergent Major Vascular Surgery

Chou

Gylys

et al. 2019

Journal of Cardiothoracic and Vascular Anesthesia

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Objectives: To evaluate whether the presence of preexisting right ventricular (RV) dysfunction in high-risk patients undergoing non-emergent major vascular surgery is associated independently with higher incidents of postoperative cardiac complications and a longer length of hospital stay. Design: Retrospective chart review. Setting: Singlecenter university hospital setting. Participants: The patient population consisted of those identified as American Society of Anesthesiologists classification III and above who had a preoperative echocardiogram within 1 year of undergoing nonemergent major vascular surgery between January 2010 and May 2017. Measurements and Main Results: After multivariate analyses, RV dysfunction (RVD) is associated independently with a higher incidence of postoperative major cardiac complications with an odds ratio = 6.3 (95% confidence interval [CI], 1.038.5; p = 0.046). In addition, patients with RVD had a 50% longer length of stay than those without RVD (incident rate ratio [95% CI], 1.5 [1.21.8]; p < 0.001). Conclusion: In this retrospective study of high-risk patients undergoing major vascular surgery, RV dysfunction was associated independently with a higher incidence of postoperative major cardiovascular events and longer length of hospital stays. Based on current findings, the prognostic value of RVD extends beyond the cardiac surgical cohort. Knowledge in management of patients with RVD in the perioperative setting should be understood by all anesthesiologists. Of note, a future study with a larger sample size is needed to validate the current findings given the small sample size of this study.

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“…A total of 24 studies looking at whether a resting radioisotope LVEF could predict adverse cardiac events in the postoperative period were identified in the English-language literature. 9 -32 One repeat publication from the same institution with overlapping study periods, 31 and a further one, using the first-pass rather than the equilibrium ventriculography, 32 were excluded. This left 22 studies for analysis, with a total of 3096 patients from 1984 to date.…”

Section: Resultsmentioning

confidence: 99%

Routine Measurement of Radioisotope Left Ventricular Ejection Fraction Prior to Vascular Surgery: Is it Worthwhile?

Karkos

Baguneid

Triposkiadis³

et al. 2004

European Journal of Vascular and Endovascular Surgery

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Twenty-two studies enrolling a total of 3096 patients were identified from 1984 to date. Selection bias, blinding of the results, different cut-off limits, and several retrospective studies were some of the problems preventing a comprehensive analysis. The resting LVEF was not found to be a consistent predictor of perioperative ischaemic cardiac events. In the perioperative phase, poor LV function was, mainly, predictive of congestive heart failure, and, in the long-term, of cardiac outcome. The presence of myocardial wall motion abnormalities was also associated with both a higher chance of postoperative cardiac complications and a worse long-term cardiac outcome. Although measurements of LV function seem to play a key role in defining a patient's long-term prognosis, the value of routinely measuring LVEF preoperatively is limited and, therefore, MUGA scanning cannot be recommended as a general screening test. Despite this, it has been widely used for cardiac risk assessment in vascular surgery, and only recently its popularity has started declining. Other tests, such as stress-echocardiography and myocardial perfusion imaging, used selectively in moderate-risk patients can refine prediction of cardiac risk. In the future, gated stress myocardial perfusion scintigraphy, perhaps combined with ANP/BNP plasma level determination, may become a first choice test in preoperative cardiac risk assessment.

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Prediction of cardiac risk before abdominal aortic reconstruction: Comparison of a revised Goldman Cardiac Risk Index and radioisotope ejection fraction

Abstract: For those patients who undergo elective abdominal aortic surgery, the revised Goldman Cardiac Risk Index is a simple method of evaluating cardiac risk with minimum resource implications. MUGA scan can offer additional stratification in patients judged with the index to be at high risk.

Cited by 17 publications

References 38 publications

The Vascular Study Group of New England Cardiac Risk Index (VSG-CRI) predicts cardiac complications more accurately than the Revised Cardiac Risk Index in vascular surgery patients

The Vascular Study Group of New England Cardiac Risk Index (VSG-CRI) predicts cardiac complications more accurately than the Revised Cardiac Risk Index in vascular surgery patients

Preexisting Right Ventricular Dysfunction Is Associated With Higher Postoperative Cardiac Complications and Longer Hospital Stay in High-Risk Patients Undergoing Nonemergent Major Vascular Surgery

Routine Measurement of Radioisotope Left Ventricular Ejection Fraction Prior to Vascular Surgery: Is it Worthwhile?

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