The Influence of Aging on the Prognostic Value of the Revised Cardiac Risk Index for Postoperative Cardiac Complications in Vascular Surgery Patients

• Published in: European journal of vascular and endovascular surgery Vol. 34; no. 6; pp. 632 - 638
• Main Authors: Welten, G.M.J.M, Schouten, O, van Domburg, R.T, Feringa, H.H.H, Hoeks, S.E, Dunkelgrün, M, van Gestel, Y.R.B.M, Goei, D, Bax, J.J, Poldermans, D
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-12-2007
• Subjects: Age Factors; Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal - mortality; Aortic Aneurysm, Abdominal - surgery; Arrhythmias, Cardiac - mortality; Arterial Occlusive Diseases - mortality; Arterial Occlusive Diseases - surgery; Cardiac Risk; Carotid Stenosis - mortality; Carotid Stenosis - surgery; Comorbidity; Coronary Artery Bypass - mortality; Cross-Sectional Studies; Elderly; Endarterectomy, Carotid - mortality; Female; Health Status Indicators; Heart Failure - mortality; Humans; Hypertension - mortality; Ischemia - mortality; Ischemia - surgery; Leg - blood supply; Male; Middle Aged; Myocardial Infarction - mortality; Postoperative Complications - mortality; Prognosis; Retrospective Studies; Stroke - mortality; Surgery; Vascular surgery; Vascular surgery; Cardiac Risk; Prognosis; Elderly
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2007.05.002

Objective The Lee-risk index [Lee-index] was developed to predict major adverse cardiac events [MACE]. However, age is not included as a risk factor. The aim was to assess the value of the Lee-index in vascular surgery patients among different age categories. Methods Of 2 642 patients cardiovascular risk factors were noted to calculate the Lee-index. Patients were divided into four age categories; ≤ 55( n = 396), 56–65 ( n = 650), 66–75 ( n = 1 058) and >75 years ( n = 538). Outcome measures were postoperative MACE (cardiac death, MI, coronary revascularization and heart failure). The performance of the Lee-index was determined using C-statistics within the four age groups. Results The incidence of MACE was 10.9%, for Lee-index 1, 2 and ≥3; 6%, 13% and 20%, respectively. However, the prognostic value differed among age groups. The predictive value for MACE was highest among patients under 55 year (0.76 vs 0.62 of patients aged > 75). The prediction of MACE improved in elderly (aged > 75) after adjusting the Lee-index with age, revised risk of operation (low, low-intermediate, high-intermediate and high-risk procedures) and hypertension (0.62 to 0.69). Conclusion The prognostic value of the Lee-index is reduced in elderly vascular surgery patients, adjustment with age, risk of surgical procedure, and hypertension improves the Lee-index significantly.