Reis Pedro Videira, Lopes Ana Isabel, Leite Diana, Moreira João, Mendes Leonor, Ferraz Sofia, Amaral Tânia, Mourão Joana, Abelha Fernando
1 São João Hospital Centre, Porto, Portugal.
2 Universidade do Porto, Porto, Portugal.
Semin Cardiothorac Vasc Anesth. 2019 Sep;23(3):293-299. doi: 10.1177/1089253218825442. Epub 2019 Jan 25.
. Patients proposed to vascular noncardiac surgery (VS) have several comorbidities associated with major adverse cardiac events (MACE). We evaluated incidence, predictors, and outcomes, and compared different scores to predict MACE after VS. . We included all patients admitted from 2006 to 2013. Perioperative MACE included cardiac arrhythmias, myocardial infarction (MI), cardiogenic pulmonary edema (CPE), acute heart failure (AHF), and cardiac arrest (CA). Lee Revised Cardiac Risk Index (RCRI), Vascular Quality Initiative (VQI-CRI), Vascular Study Group of New England (VSG-CRI), and South African Vascular Surgical (SAVS-CRI) Cardiac Risk Indexes were calculated and analyzed. We performed multivariate logistic regression to assess independent predictors with calculation of odds ratio (OR) and 95% confidence interval (CI). To reduce overfitting, we used leave-one-out cross-validation approach. The Predictive ability of scores was tested using area under receiver operating characteristic curve (AUROC). . A total of 928 patients were included. We observed 81 MACE (28 MI, 22 arrhythmias, 10 CPE, 9 AHF, 12 CA) in 60 patients (6.5%): 3.3% in intermediate-risk surgery and 9.8% in high-risk surgery. Previous history of coronary artery disease (OR = 3.2, CI = 1.8-5.7), atrial fibrillation (OR = 5.1, CI = 2.4-11.0), insulin-treated diabetes mellitus (OR = 3.26, CI = 1.51-7.06), mechanical ventilation (OR = 2.75, CI = 1.41-4.63), and heart rate (OR = 1.02, CI = 1.01-1.03) at admission were considered independent risk factors in multivariate analysis. The AUROC of our model was 0.79, compared with RCRI (0.66), VSG-CRI (0.69), VQI-CRI (0.71), and SAVS-CRI (0.73). . Observed MACE were within predicted range (1% to 5% after intermediate-risk surgery and >5% after high-risk surgery). SAVS-CRI and VQI-CRI had slightly better predictive capacity than VSG-CRI or RCRI.
拟行血管非心脏手术（VS）的患者存在多种与主要不良心脏事件（MACE）相关的合并症。我们评估了MACE的发生率、预测因素及预后，并比较了不同评分系统对VS术后MACE的预测能力。我们纳入了2006年至2013年收治的所有患者。围手术期MACE包括心律失常、心肌梗死（MI）、心源性肺水肿（CPE）、急性心力衰竭（AHF）和心脏骤停（CA）。计算并分析了Lee修订心脏风险指数（RCRI）、血管质量改进计划（VQI-CRI）、新英格兰血管研究组（VSG-CRI）和南非血管外科（SAVS-CRI）心脏风险指数。我们进行多因素逻辑回归分析以评估独立预测因素，并计算比值比（OR）和95%置信区间（CI）。为减少过度拟合，我们采用留一法交叉验证方法。使用受试者操作特征曲线下面积（AUROC）来检验评分系统的预测能力。共纳入928例患者。我们在60例患者（6.5%）中观察到81例MACE（28例MI、22例心律失常、10例CPE、9例AHF、12例CA）：中危手术患者中为3.3%，高危手术患者中为9.8%。多因素分析中，既往冠心病史（OR = 3.2，CI = 1.8 - 5.7）、心房颤动（OR = 5.1，CI = 2.4 - 11.0）胰岛素治疗的糖尿病（OR = 3.26，CI = 1.51 - 7.06）、机械通气（OR = 2.7·5，CI = 1.41 - 4.63）及入院时心率（OR = 1.02，CI = 1.01 - 1.03）被视为独立危险因素。我们模型的AUROC为0.79，而RCRI为0.66、VSG-CRI为0.69、VQI-CRI为0.71、SAVS-CRI为0.73。观察到的MACE在预测范围内（中危手术后为1%至5%，高危手术后>5%）。SAVS-CRI和VQI-CRI的预测能力略优于VSG-CRI或RCRI。
