Press Matthew J, Chassin Mark R, Wang Jason, Tuhrim Stanley, Halm Ethan A
Department of Health Policy, Mount Sinai School of Medicine, New York, NY 10029, USA.
Arch Intern Med. 2006 Apr 24;166(8):914-20. doi: 10.1001/archinte.166.8.914.
Several generic cardiac risk assessment tools predict perioperative cardiac complications, but their ability to predict a broader range of medical, neurologic, and surgical complications is unknown.
A multicenter retrospective observational cohort study of 1998 patients undergoing carotid endarterectomy (CEA). Complications within 30 days of surgery were assessed by medical record review, including death or nonfatal stroke and cardiac, noncardiac medical, minor neurologic, and wound complications. Logistic regression and receiver operating characteristic curve analyses assessed the predictive abilities of the Goldman, Detsky, Revised Cardiac Risk, and American Society of Anesthesiologists indexes and of 2 CEA-specific risk models (the Halm and Tu scores).
Death or stroke occurred in 3.2% of patients, cardiac complications in 4.0%, noncardiac medical complications in 3.2%, minor neurologic complications in 6.9%, and wound complications in 6.0%. All risk models (except the Tu score) significantly predicted cardiac complications equally well (P<.05). All 6 risk models were equivalent in predicting noncardiac medical complications. Only the Revised Cardiac Risk Index and the 2 CEA-specific risk models (Halm and Tu scores) predicted death or stroke and minor neurologic and wound complications. The Halm score was superior in predicting death or stroke compared with the Tu score and the Revised Cardiac Risk Index (area under the receiver operating characteristic curve, 0.72 vs 0.62 and 0.61, respectively; P<.05). Patients with cardiac, noncardiac medical, minor neurologic, or wound complications had 3- to 16-fold increased odds of death or stroke.
The Halm score CEA-specific risk model and the generic Revised Cardiac Risk Index predicted a broad range of medical, neurologic, and surgical complications following CEA.
几种通用的心脏风险评估工具可预测围手术期心脏并发症，但它们预测更广泛的医疗、神经和手术并发症的能力尚不清楚。
对1998例行颈动脉内膜切除术（CEA）的患者进行多中心回顾性观察队列研究。通过病历审查评估术后30天内的并发症，包括死亡或非致命性中风以及心脏、非心脏医疗、轻度神经和伤口并发症。逻辑回归和受试者工作特征曲线分析评估了戈德曼、德茨基、修订心脏风险和美国麻醉医师协会指数以及两种CEA特异性风险模型（哈尔姆和图评分）的预测能力。
3.2%的患者发生死亡或中风，4.0%发生心脏并发症，3.2%发生非心脏医疗并发症，6.9%发生轻度神经并发症，6.0%发生伤口并发症。所有风险模型（除图评分外）对心脏并发症的预测能力均相当显著（P<0.05）。所有6种风险模型在预测非心脏医疗并发症方面相当。只有修订心脏风险指数和两种CEA特异性风险模型（哈尔姆和图评分）可预测死亡或中风以及轻度神经和伤口并发症。与图评分和修订心脏风险指数相比，哈尔姆评分在预测死亡或中风方面更具优势（受试者工作特征曲线下面积分别为0.72、0.62和0.61；P<0.05）。发生心脏、非心脏医疗、轻度神经或伤口并发症的患者死亡或中风的几率增加3至16倍。
哈尔姆评分CEA特异性风险模型和通用的修订心脏风险指数可预测CEA术后广泛的医疗、神经和手术并发症。
