507 Value of Early Post-Transplant Biopsies for Predicting Long-Term Major Adverse Cardiac Events (MACE) in Heart Transplant Patients

Background. Patients undergoing kidney transplantation have increased risk of adverse cardiovascular events due to histories of hypertension, end-stage renal disease, and dialysis. As such, they are especially in need of accurate preoperative risk assessment. Methods. We compared three different risk assessment models for their ability to predict major adverse cardiac events at 30 days and 1 year after transplant. These were the PORT model, the RCRI model, and the Gupta model. We used a method based on generalized U-statistics to determine statistically significant improvements in the area under the receiver operator curve (AUC), based on a common major adverse cardiac event (MACE) definition. For the top-performing model, we added new covariates into multivariable logistic regression in an attempt to create further improvement in the AUC. Results. The AUCs for MACE at 30 days and 1 year were 0.645 and 0.650 (PORT), 0.633 and 0.661 (RCRI), and finally 0.489 and 0.557 (Gupta), respectively. The PORT model performed significantly better than the Gupta model at 1 year (p=0.039). When the sensitivity was set to 95%, PORT had a significantly higher specificity of 0.227 compared to RCRI’s 0.071 (p=0.009) and Gupta’s 0.08 (p=0.017). Our additional covariates increased the receiver operator curve from 0.664 to 0.703, but this did not reach statistical significance (p=0.278). Conclusions. Of the three calculators, PORT performed best when the sensitivity was set at a clinically relevant level. This is likely due to the unique variables the PORT model uses, which are specific to transplant patients.

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In situ skeletonized bilateral thoracic artery for left coronary circulation: a 20-year experience

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz138 ◽

2019 ◽

Vol 57 (1) ◽

pp. 160-167 ◽

Cited By ~ 1

Author(s):

Massimo Bonacchi ◽

Edvin Prifti ◽

Marco Bugetti ◽

Francesco Cabrucci ◽

Michael Cresci ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass ◽

Coronary Circulation ◽

Artery Bypass ◽

Myocardial Revascularization ◽

Major Adverse Cardiac Events ◽

Cardiac Events ◽

Adverse Cardiac Events

Abstract OBJECTIVES Our goal was to analyse the outcomes in a patient population using a standardized technique for coronary artery bypass grafting (CABG) consisting of total arterial myocardial revascularization utilizing the in situ skeletonized bilateral thoracic artery for left coronary circulation. We also explored potential predictors of long-time unfavourable outcomes. METHODS Patients undergoing total arterial myocardial revascularization using in situ skeletonized bilateral thoracic artery for left coronary circulation between January 1997 and May 2017 were included prospectively in this study. The median follow-up (100% complete) was 103 months (interquartile range 61–189 months) and ranged from 1 to 245 months. RESULTS A total of 1325 consecutive patients were recruited. During the follow-up period, there were 131 deaths (9.8%), 146 repeat revascularizations (11.0%) and 229 major adverse cardiac events (17.2%). The 18-year freedom from major adverse cardiac events was 62.6 ± 9.3%, 62.5 ± 6.3% and 53.9 ± 11.0%, respectively. Multivariable models showed that a left ventricular ejection fraction ≤35%, chronic obstructive pulmonary disease, peripheral vascular disease (P < 0.001), chronic kidney disease and age ≥80 years (P = 0.002) were independent predictors of diminished long-term survival. Moreover, peripheral vascular disease and off-pump coronary artery bypass (both, P < 0.001) predicted repeat revascularization. Finally, age ≥80 years, peripheral vascular disease, left ventricular ejection fraction ≤35%, off-pump coronary artery bypass and chronic pulmonary obstructive disease were independent predictors of major adverse cardiac events during the long-term follow-up period (all, P < 0.001). CONCLUSIONS Coronary artery bypass using the in situ skeletonized bilateral thoracic artery for left coronary circulation configuration for total arterial myocardial revascularization resulted in satisfactory long-term results with a low incidence of death and late events and may represent a technique of choice in selected patients having CABG. Larger and long-term prospective studies are, however, warranted.

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Long-term clinical outcome and predictors of major adverse cardiac events after percutaneous interventions on saphenous vein grafts

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(01)01420-6 ◽

2001 ◽

Vol 38 (3) ◽

pp. 659-665 ◽

Cited By ~ 123

Author(s):

Ellen C Keeley ◽

Carlos A Velez ◽

William W O’Neill ◽

Robert D Safian

Keyword(s):

Clinical Outcome ◽

Saphenous Vein ◽

Major Adverse Cardiac Events ◽

Cardiac Events ◽

Vein Grafts ◽

Percutaneous Interventions ◽

Saphenous Vein Grafts ◽

Adverse Cardiac Events

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Association of apical rocking with long-term major adverse cardiac events in patients undergoing cardiac resynchronization therapy

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jev236 ◽

2015 ◽

Vol 17 (2) ◽

pp. 146-153 ◽

Cited By ~ 15

Author(s):

Abdul Ghani ◽

Peter Paul H.M. Delnoy ◽

Jan Paul Ottervanger ◽

Anand R. Ramdat Misier ◽

Jaap Jan J. Smit ◽

...

Keyword(s):

Cardiac Resynchronization Therapy ◽

Major Adverse Cardiac Events ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Cardiac Events ◽

Adverse Cardiac Events ◽

Apical Rocking

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Quality of Postoperative Care after Major Orthopedic Surgery Is Correlated with Both Long-term Cardiovascular Outcome and Troponin Ic Elevation

Anesthesiology ◽

10.1097/aln.0b013e3181eaacc4 ◽

2010 ◽

Vol 113 (3) ◽

pp. 529-540 ◽

Cited By ~ 11

Author(s):

Sylvain Ausset ◽

Yves Auroy ◽

Catherine Verret ◽

Dan Benhamou ◽

Philippe Vest ◽

...

Keyword(s):

Orthopedic Surgery ◽

Postoperative Care ◽

Major Adverse Cardiac Events ◽

Cardiac Events ◽

Care Policy ◽

Adverse Cardiac Events ◽

Major Orthopedic Surgery ◽

Cardiac Outcome

Background The aim of this study performed in patients undergoing major orthopedic surgery was to assess the impact of changes in practice on both the incidence of postoperative myocardial ischemia (PMI) detected by serial measurements of troponin Ic and long-term cardiac outcome. Methods During a 3-yr period, troponin Ic was measured on the first 3 days after major orthopedic surgery in a multidisciplinary hospital. After 16 months of study, postoperative care was improved. Cardiac death, myocardial infarction, and cardiac failure were considered major adverse cardiac events and were recorded during the hospital stay and the first postoperative year. The incidences of PMI and major adverse cardiac events were used as result indicators for quality of care and compared before (P1) and after (P2) quality enhancement. Results Three hundred seventy-eight surgical procedures were included (P1, 123; P2, 255). Incidences of PMI and major adverse cardiac events were 8.9 versus 3.9% (P=0.04) and 8.1 versus 1.9% (P=0.004) for P1 and P2, respectively. Using a multivariate Cox regression analysis adjusted for baseline data, independent factors associated with the occurrence of a major adverse cardiac event were phase P1 (hazard ratio=4.5; 97.8% confidence interval [CI], 1.1-17.4) and PMI (Hazard ratio=6.4; 97.8% CI, 1.6-26.4). Conclusions Our postoperative care policy after major orthopedic surgery strongly correlated with both short-term cardiac outcome (i.e., PMI with troponin Ic release) and long-term cardiac outcome. Thus, in a given surgical population, variation of incidence of troponin Ic elevations could be used as a result indicator for postoperative care policy.

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