scholarly journals The added value of different biomarkers to the Revised Cardiac Risk Index to predict major adverse cardiac events and all-cause mortality after noncardiac surgery

2018 ◽  
Author(s):  
Lisette M Vernooij ◽  
Johanna AAG Damen ◽  
Wilton A van Klei ◽  
Karel Moons ◽  
Linda M Peelen
Keyword(s):  
Risk Index ◽  
Cardiac Risk ◽  
Noncardiac Surgery ◽  
Major Adverse Cardiac Events ◽  
Added Value ◽  
Cardiac Events ◽  
Cardiac Risk Index ◽  
Adverse Cardiac Events ◽  
All Cause Mortality

Cardiac risk assessment with the Revised Cardiac Risk Index index before elective non-cardiac surgery: A retrospective audit from an Australian tertiary hospital

2021 ◽  
pp. 0310057X2110246
Author(s):  
Yao Yao ◽  
Ashok Dharmalingam ◽  
Cyril Tang ◽  
Harrison Bell ◽  
Andrew DJ McKeown ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Risk Index ◽  
Cardiac Risk ◽  
Tertiary Hospital ◽  
Major Adverse Cardiac Events ◽  
Cardiac Complications ◽  
Cardiac Events ◽  
Prognostic Accuracy ◽  
Cardiac Risk Index ◽  
Adverse Cardiac Events

Clinicians assessing cardiac risk as part of a comprehensive consultation before surgery can use an expanding set of tools, including predictive risk calculators, cardiac stress tests and measuring serum natriuretic peptides. The optimal assessment strategy is unclear, with conflicting international guidelines. We investigated the prognostic accuracy of the Revised Cardiac Risk Index for risk stratification and cardiac outcomes in patients undergoing elective non-cardiac surgery in a contemporary Australian cohort. We audited the records for 1465 consecutive patients 45 years and older presenting to the perioperative clinic for elective non-cardiac surgery in our tertiary hospital. We calculated individual Revised Cardiac Risk Index scores and documented any use of preoperative cardiac tests. The primary outcome was any major adverse cardiac events within 30 days of surgery, including myocardial infarction, pulmonary oedema, complete heart block or cardiac death. Myocardial perfusion imaging was the most common preoperative stress test (4.2%, 61/1465). There was no routine investigation of natriuretic peptide levels for cardiac risk assessment before surgery. Major adverse cardiac events occurred in 1.3% (18/1366) of patients who had surgery. The Revised Cardiac Risk Index score had modest prognostic accuracy for major cardiac complications, area under receiver operator curve 0.73, 95% confidence interval 0.60 to 0.86. Stratifying major adverse cardiac events by the Revised Cardiac Risk Index scores 0, 1, 2 and 3 or greater corresponded to event rates of 0.6% (4/683), 0.8% (4/488), 4.1% (6/145) and 8.0% (4/50), respectively. The Revised Cardiac Risk Index had only modest predictive value in our single-centre experience. Patients with a revised cardiac risk index score of 2 or more had an elevated risk of early cardiac complications after elective non-cardiac surgery.

scholarly journals Prognostic Value of Systemic Immune-Inflammation Index for Major Adverse Cardiac Events and Mortality in Severe Aortic Stenosis Patients after TAVI

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 588
Author(s):  
Aydin Rodi Tosu ◽  
Muhsin Kalyoncuoglu ◽  
Halil İbrahim Biter ◽  
Sinem Cakal ◽  
Murat Selcuk ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Prognostic Value ◽  
Major Adverse Cardiac Events ◽  
Cardiac Events ◽  
Short Term ◽  
Cox Regression Analysis ◽  
Adverse Cardiac Events ◽  
All Cause Mortality ◽  
Auc Value ◽  
Immune Inflammation

Background and objectives: In this study, we aimed to evaluate whether the systemic immune-inflammation index (SII) has a prognostic value for major adverse cardiac events (MACEs), including stroke, re-hospitalization, and short-term all-cause mortality at 6 months, in aortic stenosis (AS) patients who underwent transcatheter aortic valve implantation (TAVI). Materials and Methods: A total of 120 patients who underwent TAVI due to severe AS were retrospectively included in our study. The main outcome of the study was MACEs and short-term all-cause mortality at 6 months. Results: The SII was found to be higher in TAVI patients who developed MACEs than in those who did not develop them. Multivariate Cox regression analysis revealed that the SII (HR: 1.002, 95%CI: 1.001–1.003, p < 0.01) was an independent predictor of MACEs in AS patients after TAVI. The optimal value of the SII for MACEs in AS patients following TAVI was >1.056 with 94% sensitivity and 96% specificity (AUC (the area under the curve): 0.960, p < 0.01). We noted that the AUC value of SII in predicting MACEs was significantly higher than the AUC value of the C-reactive protein (AUC: 0.960 vs. AUC: 0.714, respectively). Conclusions: This is the first study to show that high pre-procedural SII may have a predictive value for MACEs and short-term mortality in AS patients undergoing TAVI.

scholarly journals P238 RA and multimorbidity in UK Biobank: association with all-cause mortality and major adverse cardiac events

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Barbara Nicholl ◽  
Ross McQueenie ◽  
Bhautesh Jani ◽  
Sara Macdonald ◽  
Colin McCowan ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Major Adverse Cardiac Events ◽  
Uk Biobank ◽  
Cardiac Events ◽  
Long Term Conditions ◽  
Increased Risk ◽  
Adverse Cardiac Events ◽  
Wide Range ◽  
All Cause Mortality

Abstract Background Multimorbidity, the presence of ≥ 2 long-term conditions (LTCs) is common in people with rheumatoid arthritis (RA). However, most research in RA has focused on cardiovascular disease and depression as co-occurring morbidities, rather than multiple LTCs or a wide range of conditions. This study hypothesised that risk of all-cause mortality and major adverse cardiac events (MACE) would be greater in those with RA and ≥2 LTCs than those with RA only. Further, we explored which individual LTCs were associated with increased risk of mortality and MACE. Methods Data from UK Biobank, a cohort of over 500,000 adults aged 37-73 years across England, Scotland and Wales was analysed. RA and 42 other LTCs of interest were self-reported by participants in a questionnaire and nurse-led interview. Information on sociodemographic (age, gender, socioeconomic status) and lifestyle factors (smoking status, BMI, alcohol frequency, physical activity) were also gathered. Rheumatoid factor levels were also determined. MACE and mortality were classified using linked hospitalisations and mortality register data (median follow up time 9 years). Data were analysed using age-adjusted Cox’s proportional hazard modelling to calculate risk of all-cause mortality or MACE, adjusted for variables listed above. Predictor variable: no RA no LTCs (reference group), only RA, RA + 1-3LTCs, RA + ≥4LTCs. Finally, the relationship between comorbidity with individual LTCs (of the 42 studied) and both health outcomes was considered. Results 5,658 (1.1%) of participants in UK Biobank self-reported RA (69.8% female, mean age 59 years). 74.7% of participants reported at least one LTC in addition to RA (1-3 LTCs 64.3%, ≥4 LTCs 10.4%), compared to 63.8% of participants without RA. 7.7% (N = 437) of participants with RA died and 5.9% (n = 331) had MACE events during the follow-up period. There was a dose response relationship in RA between LTC category and all-cause mortality and MACE risk. Only RA: mortality HR 1.42, 95% CI 1.08, 1.87, MACE HR 1.61 95% CI 1.20, 2.18; RA + 1-3LTCs: mortality HR 1.99 95% CI 1.74, 2.27, MACE HR 1.89, 95% CI 1.61, 2.20; RA + ≥4LTCs: mortality HR 3.34, 95% CI 2.64, 4.22; MACE HR 3.45, 95% CI 2.66, 4.49) compared to those with no RA no LTCs (results presented from fully adjusted models). Of the 42 individual LTCs considered, comorbid osteoporosis was the most concerning; participants with both RA and osteoporosis had a two-fold increased risk of all-cause mortality (HR 2.20, 95% CI 1.55, 3.12) and three-fold increased risk of MACE outcomes (HR 3.17, 95% CI 2.17, 4.64) compared to those with neither condition. Conclusion Participants with RA and multimorbidity or comorbidity, particularly osteoporosis, are at increased risk of adverse health outcomes. These results have important clinical relevance for the monitoring and optimal management of RA across the healthcare system. Disclosures B. Nicholl None. R. McQueenie None. B. Jani None. S. Macdonald None. C. McCowan None. J. Canning None. F. Mair None. S. Siebert None.

Abstract 15582: Patterns of Statin Initiation in Patients Undergoing Intermediate to High Risk Non-Cardiac Surgery

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Elisabetta Patorno ◽  
Shirley Wang ◽  
Sebastian Schneeweiss ◽  
Jun Liu ◽  
Brian Bateman
Keyword(s):  
Cardiac Surgery ◽  
High Risk ◽  
Vascular Surgery ◽  
Elective Surgery ◽  
Risk Index ◽  
Cardiac Risk ◽  
Cardiac Events ◽  
Initiation Rate ◽  
Cardiac Risk Index ◽  
Recent Estimate

Background: Starting from early to mid 2000s a growing body of literature has been produced on the potential role of statins in reducing perioperative cardiac events in patients undergoing non-cardiac surgery. However, evidence remains inconsistent and little is known regarding the use of perioperative statins in clinical practice. Objectives: To examine pattern of statin initiation among patients undergoing non-cardiac elective surgery in the US. Methods: Using data from a large US healthcare insurer, we identified patients ≥18 years who underwent moderate- to high-risk non-cardiac elective surgery and initiated statins within 30-days before surgery. We assessed trends of statin initiation over time and predictors of initiation. To ensure statin initiation was precipitated by non-cardiac surgery vs. alternative indications, we also assessed the effect of temporal proximity to surgery on initiation in a matched analysis. Results: Of 460,154 patients undergoing surgery between 2003-2012, 5,628 (1.2%) initiated a statin before surgery. Initiation rate increased from 0.8% in 2003 to 1.5% in 2012 (p = .0004). The increase was more pronounced among patients with revised cardiac risk index (RCRI) score ≥2 and patients undergoing vascular surgery, with initiation rates equal to 7.2% and 14.9% respectively by the end of 2012. Proximity to surgery was predictive of statin initiation (p < .0001). Significant predictors of initiation were older age, male sex, revised cardiac risk index (RCRI) score ≥1, vascular or orthopedic surgery. At the most recent estimate, patients undergoing vascular surgery and with a RCRI score ≥2 had initiation rates equal to 19.9%. Conclusions: The rate of statin initiation progressively increased from 2003 to 2012, particularly among patients with higher RCRI score and undergoing major vascular surgery. Research is needed to further define the risks and benefits of initiation of statins prior to surgery.

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