Prediction of major cardiac events after vascular surgery

Gualandro, Danielle Menosi; Puelacher, Christian; Buse, Giovanna Lurati; Llobet, Gisela Biagio; Yu, Pai Ching; Cardozo, Francisco Akira Malta; Glarner, Noemi; A, Zimmerli; Espinola, Jaqueline; Corbière, Sydney; Calderaro, Daniela; Marques, Ana Paula; Casella, Ivan Benaduce; Luccia, Nélson De; Oliveira, Múcio Tavares de; Lampart, Andreas; Bolliger, Daniel; Steiner, Luzius A.; Seeberger, Manfred; Kindler, Christoph; Oßwald, Stefan; Gürke, Lorenz; Caramelli, Bruno

doi:10.1016/j.jvs.2017.05.100

Cited by 26 publications

(16 citation statements)

References 44 publications

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“…In addition, we used a more sensitive troponin T assay (hs-cTnT), and if we had considered a high troponin blood concentration (above the 99th percentile) alone as myocardial infarction or injury, 48% of our patients who underwent carotid endarterectomy would have had a cardiac event. On the other hand, Moses et al 2 did not perform surveillance, as it was a retrospective study, and described a rate of cardiac event after carotid endarterectomy of 2%, much lower than described in our cohort 3 and in the cohort of Galyfos et al, 4 which were prospective studies with surveillance. This is expected, once most perioperative myocardial infarctions have no symptoms and are likely to be missed without surveillance.…”

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confidence: 51%

“…Because there is no consensus on a perioperative myocardial infarction definition, the use of different criteria among studies leads to differences in cardiac event rates and differences in preoperative risk score accuracy. As Dr Galyfos and Dr Filis highlighted, there were differences in the rate of perioperative myocardial injury from our cohort 3 and theirs, 4 likely due to differences in diagnostic criteria and in the sensitivity of the troponin assays used for surveillance. In our cohort, we used the third universal definition of myocardial infarction 5 criteria for diagnosis of perioperative myocardial infarction, which means only patients with high troponin levels and at least one of the additional criteria (clinical symptoms, electrocardiogram or echocardiogram changes) were diagnosed with myocardial infarction.…”

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confidence: 84%

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Gualandro

Caramelli

Puelacher

et al. 2018

Journal of Vascular Surgery

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confidence: 51%

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confidence: 84%

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Gualandro

Caramelli

Puelacher

et al. 2018

Journal of Vascular Surgery

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“…The addition of hsTnT and NT-proBNP improved the medium quality of RCRI in the estimation of postoperative myocardial infarction in noncardiac surgery by increasing the AUC by 12.6% [26]. A study that defined MACE in a similar way to our study demonstrated the low accuracy and underestimation of MACE by RCRI and another specific risk model for vascular surgery [27]. Although we were not able to demonstrate the importance of individual markers in the prediction of postoperative cardiovascular events, in a recently published study, we showed the importance of midregional proadrenomedulin as a single predictive marker measured preoperatively [28, 29].…”

Section: Discussionmentioning

confidence: 75%

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

Golubović¹,

Perić²,

Stanojević³

et al. 2018

Med Princ Pract

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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.

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“…Several of the other commonly used indices were found to have significantly lower discriminatory power when applied in external datasets other than the ones in which they were derived. 16,17 On the other hand, one of our study limitations is that the NSQIP dataset is a comprehensive registry of all types of surgery and thus it does not record some data elements that might be significant for a specific type of surgery such as vascular surgery. Hence, we could not perform direct comparison with other indices because some of their data elements are not coded in the NSQIP database.…”

Section: Discussionmentioning

confidence: 99%

Performance of the AUB-HAS2 Cardiovascular Risk Index in vascular surgery patients

et al. 2021

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The American University of Beirut (AUB)-HAS2 risk index is a recently published tool for preoperative cardiovascular evaluation. It is based on six data elements: history of Heart disease, symptoms of Heart disease (angina or dyspnea), Age ⩾ 75 years, Anemia (hemoglobin < 12 mg/dL), emergency Surgery, and vascular Surgery. This study analyzes the performance of a modified AUB-HAS2 index (excluding the vascular surgery element) in a broad spectrum of vascular surgery procedures. The study population consisted of 90,476 vascular surgeries registered in the American College of Surgeons National Surgical Quality Improvement Program database. The performance of the AUB-HAS2 index was studied in seven groups: carotid endarterectomy (CEA), open abdominal aortic aneurysm surgical repair (OAAA), endovascular aortic aneurysm repair, supra-inguinal bypass, infra-inguinal bypass, lower extremity thrombo-endarterectomy, and lower extremity angioplasty. The outcome measure was death, myocardial infarction, or stroke at 30 days after surgery. Each patient was given an AUB-HAS2 score of 0, 1, 2, or > 2 depending on the number of data elements s/he has. The AUB-HAS2 index was able to stratify risk in the majority of patients into low (< 3%, score 0), intermediate (3–10%, score 1–2), and high (> 10%, score > 2) ( p < 0.0001). The receiver operating curve had an area of 0.71 in the overall group and it ranged from 0.60 in CEA patients to 0.75 in OAAA patients. In conclusion, the AUB-HAS2 index is a simple tool that can quickly and effectively stratify the risk of patients undergoing a broad spectrum of vascular surgeries into low, intermediate, and high.

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Prediction of major cardiac events after vascular surgery

Cited by 26 publications

References 44 publications

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

Performance of the AUB-HAS2 Cardiovascular Risk Index in vascular surgery patients

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