Università Cattolica del S.Cuore, Department of Cardiovascular Sciences, Vascular Surgery Unit, "Policlinico Universitario A. Gemelli" Foundation, Rome, Italy.
Università Cattolica del S.Cuore, Department of Hygiene, Institute of Public Health, Rome, Italy.
Int J Cardiol. 2019 Feb 15;277:224-228. doi: 10.1016/j.ijcard.2018.09.031. Epub 2018 Sep 10.
Low reliability of Revised Cardiac Risk Index (RCRI) in predicting major cardiac events (MACE) among Vascular Surgery patients emerged in recent literature, suggesting procedure-specific risk evaluation - particularly in major surgery.
METHODS-RESULTS: Comorbidities, perioperative variables, RCRI and MACE were retrospectively analyzed in a consecutive series of 899 elective open abdominal aortic aneurysm (AAA) repairs performed at our Institution. Possible MACE predictors were studied through univariate/multivariable analysis (logistic regression, MVRE) and stepwise-backward elimination/odds ratio (MVR-SBE/OR). Patients were divided by clampsite in 2 subgroups: 1. infrarenal (690 cases); 2. pararenal (209 cases). RCRI resulted predictive for MACE in the whole dataset but its performance resulted lower for pararenal aneurysms (p = 0.11) than for infrarenal ones (p ≤ 0.00). Among RCRI covariates of the whole cohort, dilated cardiomyopathy (p ≤ 0.001), ischemic cardiopathy (p ≤ 0.01) and cerebrovascular disease (p ≤ 0.02) resulted predictive. Peripheral arteriopathy also related to MACE (p ≤ 0.03). At MVR-SBE/OR analysis, the following resulted to be MACE predictors: dilated cardiomyopathy (p ≤ 0.001), cerebrovascular disease (p ≤ 0.02), and surgical access (p = 0.04) in subgroup 1; previous myocardial infarction (p ≤ 0.01), congestive failure (p ≤ 0.03) and chronic pneumopathy (p = 0.04) in subgroup 2.
Predictability of RCRI in elective AAA surgery is influenced by clampsite and resulted to be lower in aneurysms requiring suprarenal clamping. Variables included in the RCRI show to have different weights when patients are stratified by clampsite. Some variables not included in the RCRI model significantly affect the onset of MACE. RCRI should be revised to elaborate a specific score for AAAs including further MACE predictors, to improve risk assessment and to support proper surgical strategy.
最近的文献表明，修订后的心脏风险指数（RCRI）在预测血管外科患者的主要心脏事件（MACE）方面可靠性较低，这表明需要进行特定于手术的风险评估-特别是在大型手术中。
方法-结果：在我们机构连续进行的 899 例择期开放式腹主动脉瘤（AAA）修复中，回顾性分析了合并症、围手术期变量、RCRI 和 MACE。通过单变量/多变量分析（逻辑回归、MVRE）和逐步向后消除/优势比（MVR-SBE/OR）研究可能的 MACE 预测因子。患者根据夹闭部位分为 2 个亚组：1. 肾下（690 例）；2. 肾周（209 例）。RCRI 对整个数据集的 MACE 具有预测性，但对肾周动脉瘤的预测性能较低（p=0.11），而对肾下动脉瘤的预测性能较高（p≤0.00）。在整个队列的 RCRI 协变量中，扩张型心肌病（p≤0.001）、缺血性心脏病（p≤0.01）和脑血管疾病（p≤0.02）具有预测性。外周血管疾病也与 MACE 相关（p≤0.03）。在 MVR-SBE/OR 分析中，以下结果是 MACE 的预测因子：扩张型心肌病（p≤0.001）、脑血管疾病（p≤0.02）和手术入路（p=0.04）在亚组 1；既往心肌梗死（p≤0.01）、充血性心力衰竭（p≤0.03）和慢性肺部疾病（p=0.04）在亚组 2。
RCRI 在择期 AAA 手术中的预测能力受夹闭部位的影响，在需要肾上夹闭的动脉瘤中，其预测能力较低。当根据夹闭部位对患者进行分层时，RCRI 中包含的变量显示出不同的权重。一些未包含在 RCRI 模型中的变量会显著影响 MACE 的发生。应修订 RCRI，制定包含进一步的 MACE 预测因子的特定 AAA 评分，以改善风险评估并支持适当的手术策略。
