Cardiac Risk Assessment, Morbidity Prediction, and Outcome in the Vascular Intensive Care Unit.

Hdl Handle:
http://hdl.handle.net/10147/304747
Title:
Cardiac Risk Assessment, Morbidity Prediction, and Outcome in the Vascular Intensive Care Unit.
Authors:
Dover, Mary; Tawfick, Wael; Sultan, Sherif
Citation:
Cardiac Risk Assessment, Morbidity Prediction, and Outcome in the Vascular Intensive Care Unit. 2013: Vasc Endovascular Surg
Publisher:
Vascular and endovascular surgery
Journal:
Vascular and endovascular surgery
Issue Date:
17-Sep-2013
URI:
http://hdl.handle.net/10147/304747
DOI:
10.1177/1538574413502551
PubMed ID:
24048256
Abstract:
Objectives: The aim of this study is to examine the predictive value of the Lee revised cardiac risk index (RCRI) for a standard vascular intensive care unit (ICU) population as well as assessing the utility of transthoracic echocardiography and the impact of prior coronary artery disease (CAD) and coronary revascularization on patient outcome. Design: This is a retrospective review of prospectively maintained Vascubase and prospectively collected ICU data. Materials and Methods: Data from 363 consecutive vascular ICU admissions were collected. Findings were used to calculate the RCRI, which was then correlated with patient outcomes. All patients were on optimal medical therapy (OMT) in the form of cardioselective β-blocker, aspirin, statin, and folic acid. Results: There was no relationship found between a reduced ejection fraction and patient outcome. Mortality was significantly increased for patients with left ventricular hypertrophy (LVH) as identified on echo (14.9% vs 6.5%, P = .028). The overall complication rates were significantly elevated for patients with valvular dysfunction. Discrimination for the RCRI on receiver-operating characteristic analysis was poor, with an area under the receiver-operating characteristic curve of .621. Model calibration was reasonable with an Hosmer-Lemeshow Ĉ statistic of 2.726 (P = .256). Of those with known CAD, 41.22% of the patients receiving best medical treatment developed acute myocardial infarction (AMI) compared to 35.3% of those who previously underwent percutaneous cardiac intervention and 23.5% of those who had undergone coronary artery bypass grafting. There was 3-fold increase in major adverse clinical events in patients with troponin rise and LVH. Conclusions: The RCRI's discriminatory capacity is low, and this raises difficulties in assessing cardiac risk in patients undergoing vascular intervention. The AMI is highest in the OMT group without prior cardiac intervention, which mandates protocols to identify patients requiring cardiac intervention prior to vascular procedures.
Item Type:
Article
Language:
en
ISSN:
1938-9116

Full metadata record

DC FieldValue Language
dc.contributor.authorDover, Maryen_GB
dc.contributor.authorTawfick, Waelen_GB
dc.contributor.authorSultan, Sherifen_GB
dc.date.accessioned2013-10-30T11:50:53Z-
dc.date.available2013-10-30T11:50:53Z-
dc.date.issued2013-09-17-
dc.identifier.citationCardiac Risk Assessment, Morbidity Prediction, and Outcome in the Vascular Intensive Care Unit. 2013: Vasc Endovascular Surgen_GB
dc.identifier.issn1938-9116-
dc.identifier.pmid24048256-
dc.identifier.doi10.1177/1538574413502551-
dc.identifier.urihttp://hdl.handle.net/10147/304747-
dc.description.abstractObjectives: The aim of this study is to examine the predictive value of the Lee revised cardiac risk index (RCRI) for a standard vascular intensive care unit (ICU) population as well as assessing the utility of transthoracic echocardiography and the impact of prior coronary artery disease (CAD) and coronary revascularization on patient outcome. Design: This is a retrospective review of prospectively maintained Vascubase and prospectively collected ICU data. Materials and Methods: Data from 363 consecutive vascular ICU admissions were collected. Findings were used to calculate the RCRI, which was then correlated with patient outcomes. All patients were on optimal medical therapy (OMT) in the form of cardioselective β-blocker, aspirin, statin, and folic acid. Results: There was no relationship found between a reduced ejection fraction and patient outcome. Mortality was significantly increased for patients with left ventricular hypertrophy (LVH) as identified on echo (14.9% vs 6.5%, P = .028). The overall complication rates were significantly elevated for patients with valvular dysfunction. Discrimination for the RCRI on receiver-operating characteristic analysis was poor, with an area under the receiver-operating characteristic curve of .621. Model calibration was reasonable with an Hosmer-Lemeshow Ĉ statistic of 2.726 (P = .256). Of those with known CAD, 41.22% of the patients receiving best medical treatment developed acute myocardial infarction (AMI) compared to 35.3% of those who previously underwent percutaneous cardiac intervention and 23.5% of those who had undergone coronary artery bypass grafting. There was 3-fold increase in major adverse clinical events in patients with troponin rise and LVH. Conclusions: The RCRI's discriminatory capacity is low, and this raises difficulties in assessing cardiac risk in patients undergoing vascular intervention. The AMI is highest in the OMT group without prior cardiac intervention, which mandates protocols to identify patients requiring cardiac intervention prior to vascular procedures.en_GB
dc.languageENG-
dc.language.isoenen
dc.publisherVascular and endovascular surgeryen_GB
dc.rightsArchived with thanks to Vascular and endovascular surgeryen_GB
dc.titleCardiac Risk Assessment, Morbidity Prediction, and Outcome in the Vascular Intensive Care Unit.en_GB
dc.typeArticleen
dc.identifier.journalVascular and endovascular surgeryen_GB
dc.description.fundingNo fundingen
dc.description.provinceLeinsteren
dc.description.peer-reviewpeer-reviewen

Related articles on PubMed

All Items in Lenus, The Irish Health Repository are protected by copyright, with all rights reserved, unless otherwise indicated.