Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal.
Department of Anesthesiology, Centro Hospitalar Universitário de São João, Porto, Portugal.
Vasa. 2022 Mar;51(2):93-98. doi: 10.1024/0301-1526/a000988. Epub 2022 Feb 16.
Cardiac complications represent the main cause of mortality after non-cardiac surgery and the Revised Cardiac Risk Index (RCRI) was created to estimate the perioperative risk of these events. It considers history of ischaemic heart disease, congestive heart failure, diabetes requiring preoperative insulin, stroke or transient ischaemic attack and renal impairment. We aim to describe the accuracy of the RCRI for predicting perioperative major adverse cardiovascular events (MACE) - a composite of heart failure, ischemic events and all-cause death. Also, the authors aimed to review the score for better prediction of cardiovascular outcomes. From January 2012 to January 2020, patients who underwent Carotid endarterectomy (CEA) with regional anaesthesia (RA) were selected. RCRI was calculated for each case. Estimated and reported cardiovascular complications were compared using multivariate logistic regression and cox proportional hazards. An alternative and optimized carotid-RCRI (CtRCRI) was obtained. Overall predictive accuracy was assessed and compared by measuring model discrimination. Adjustments for overfitting and evaluation of the new model were performed by bootstrap. 186 patients were selected, of which 80% were male with a mean age of 70.0±9.05 years old. The median follow-up was 50 months, interquartile range 21-69 months. None of the scores were able to predict MACE in the perioperative period. Both were associated with 30-day Clavien-Dindo ≥2 (p=0.022 and p=0.041, respectively). Regarding long-term prognosis, both were able to predict MACE (RCRI: hazard ratio (HR) 3.54 (95% confidence interval [CI] 1.04-11.48) vs. CtRCRI: HR 2.08 (95%CI 1.08-3.98) and all-cause mortality (RCRI: HR 3.33, 95%CI 0.99-11.11 vs. CtRCRI: HR 1.57, 95%CI 1.14-7.04). RCRI and CtRCRI did not predict MACE in the perioperative period but are good predictors of 30-day complications (Clavien-Dindo ≥2). Both RCRI and CtRCRI have good prognostic value as predictors of long-term cardiovascular events.
心脏并发症是非心脏手术后主要的死亡原因，修订后的心脏风险指数（RCRI）用于评估这些事件的围手术期风险。它考虑了缺血性心脏病、充血性心力衰竭、术前需要胰岛素治疗的糖尿病、中风或短暂性脑缺血发作以及肾功能损害的病史。我们旨在描述 RCRI 预测围手术期主要不良心血管事件（MACE）的准确性 - 心力衰竭、缺血事件和全因死亡的综合指标。此外，作者旨在回顾该评分以更好地预测心血管结局。 从 2012 年 1 月至 2020 年 1 月，选择接受区域麻醉（RA）颈动脉内膜切除术（CEA）的患者。为每个病例计算 RCRI。使用多变量逻辑回归和 Cox 比例风险比较估计和报告的心血管并发症。获得替代和优化的颈动脉-RCRI（CtRCRI）。通过测量模型判别来评估和比较整体预测准确性。通过自举进行过度拟合调整和新模型评估。 共选择了 186 名患者，其中 80%为男性，平均年龄为 70.0±9.05 岁。中位随访时间为 50 个月，四分位间距为 21-69 个月。没有一个评分能够预测围手术期的 MACE。两者均与 30 天 Clavien-Dindo≥2 相关（p=0.022 和 p=0.041）。关于长期预后，两者都能够预测 MACE（RCRI：风险比（HR）3.54（95%置信区间[CI] 1.04-11.48）与 CtRCRI：HR 2.08（95%CI 1.08-3.98）和全因死亡率（RCRI：HR 3.33，95%CI 0.99-11.11 与 CtRCRI：HR 1.57，95%CI 1.14-7.04）。 RCRI 和 CtRCRI 不能预测围手术期的 MACE，但对 30 天并发症（Clavien-Dindo≥2）有良好的预测作用。RCRI 和 CtRCRI 均具有良好的预后价值，可预测长期心血管事件。
