title: A long-term survival score improves preoperative prediction of survival following major vascular surgery.
abstract: BACKGROUND
  In a previous study it has been shown that a long-term survival score (LTSS), composed of Lee's Revised Cardiac Risk Index (RCRI) criteria supplemented by age, preoperative electrocardiography (EKG) features, and all types of diabetes to the RCRI criteria, predicts long-term (3-15 years) survival after major vascular surgery. The present study aimed to investigate the performance of LTSS in predicting earlier survival (3 months-3 years) as compared with the RCRI.
  
  
  METHODS
  Data from 921 consecutive patients undergoing major vascular surgery (624 patients at Hadassah Medical Center [HMC] and 296 patients in Beth Israel Deaconess Medical Center [BIDMC]) were collected retrospectively. The LTSS was seven points that included the five RCRI factors as well as age >65 years and ST-segment depression on preoperative EKG. Logistic regression and receiver operating characteristic curve (ROC) curve analyses were used to compare the 3 months-3 years mortality between the RCRI and LTSS.
  
  
  RESULTS
  The Beth Israel Deaconess Medical Center patients were sicker than the Hadassah Medical Center patients, with higher RCRI (1.2 ± 1.0 vs. 0.81 ± 0.83, p < 0.001) and LTSS (2.6 ± 1.4 vs. 1.7 ± 1.2, p < 0.001) and higher 3-years mortality (36.3% vs. 20.7%, p = 0.005). The LTSS predicted mortality better than RCRI as measured by the area under the ROC curves at all time points between 6 months (0.66 ± 0.03 vs. 0.57 ± 0.04, p = 0.02) and 3 years (0.70 ± 0.02 vs. 0.61 ± 0.02, p < 0.0001) in both institutions, but not 3-months mortality. The LTSS also provided better discrimination between each adjacent two-risk score than the RCRI.
  
  
  CONCLUSIONS
  Age >65 years, ST-segment depression on preoperative 12-lead EKG, and all types of diabetes added to the RCRI significantly improved the preoperative prediction of mortality after 6 months following major vascular surgery.
authors.affiliation: Department of Anesthesia, Beth Israel Deaconess, Harvard Medical School, Boston, MA, USA. bsubrama@bidmc.harvard.edu
authors.forename: Balachundhar
authors.initials: B
authors.lastname: Subramaniam
authors.forename: Yuval
authors.initials: Y
authors.lastname: Meroz
authors.forename: Daniel
authors.initials: D
authors.lastname: Talmor
authors.forename: Frank B
authors.initials: FB
authors.lastname: Pomposelli
authors.forename: Yaacov
authors.initials: Y
authors.lastname: Berlatzky
authors.forename: Giora
authors.initials: G
authors.lastname: Landesberg
mesh_terms: D000046:Academic Medical Centers; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001900:Boston; D016009:Chi-Square Distribution; D003920:Diabetes Mellitus / Q000401:mortality; D004562:Electrocardiography; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007557:Israel; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D057234:Preoperative Period; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D017741:Survivors / Q000706:statistics & numerical data*; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000401:mortality*