The influence of aging on the prognostic value of the revised cardiac risk index for postoperative cardiac complications in vascular surgery patients.
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 2642 patients cardiovascular risk factors were noted to calculate the Lee-index. Patients were divided into four age categories; < or = 55 (n=396), 56-65 (n=650), 66-75 (n=1058) 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 > or = 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).


CONCLUSIONS
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.
Welten
G M J M
GM
Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
Schouten
O
O
van Domburg
R T
RT
Feringa
H H H
HH
Hoeks
S E
SE
Dunkelgrün
M
M
van Gestel
Y R B M
YR
Goei
D
D
Bax
J J
JJ
Poldermans
D
D
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D001145:Arrhythmias, Cardiac / Q000401:mortality*; D001157:Arterial Occlusive Diseases / Q000401:mortality / Q000601:surgery*; D016893:Carotid Stenosis / Q000401:mortality / Q000601:surgery; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000401:mortality*; D003430:Cross-Sectional Studies; D016894:Endarterectomy, Carotid / Q000401:mortality; D005260:Female; D006305:Health Status Indicators; D006333:Heart Failure / Q000401:mortality*; D006801:Humans; D006973:Hypertension / Q000401:mortality; D007511:Ischemia / Q000401:mortality / Q000601:surgery; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D020521:Stroke / Q000401:mortality*