title: A new revised cardiac risk index incorporating fragmented QRS complex as a prognostic marker in patients undergoing noncardiac vascular surgery.
abstract: The aim of this study was to investigate the value of a new Revised Cardiac Risk Index (RCRI) that includes consideration of QRS fragmentation (fQRS) as a predictor of cardiac events in patients undergoing noncardiac vascular surgery. Four hundred sixty-seven consecutive patients admitted for noncardiac vascular surgery were studied. Patients were allocated to RCRI 0, 1, 2, or ≥3 groups according to the sum of diabetes, renal insufficiency, and histories of ischemic heart disease, congestive heart failure, and cerebrovascular disease. They were then reallocated to fragmented RCRI (fRCRI) 0, 1, 2, or ≥3 groups after including a score of 1 or 0 corresponding to the presence or absence of fQRS. A major adverse cardiac event (MACE) was defined as a composite of death, myocardial infarction, congestive heart failure, and percutaneous coronary intervention before noncardiac vascular surgery. During index hospitalization, MACE developed in 38 patients (8.1%). fQRS was present in 169 (36.2%), and it was significantly greater in patients with MACE than in those without MACE (63.2% vs 34.3%, p <0.001). The proportions of RCRI 0, 1, 2, and ≥3 were 46.9% (n = 219), 35.3% (n = 165), 12.4% (n = 58), and 5.4% (n = 25), respectively. When fRCRI data were included, 28 patients (48.3%) in RCRI 2 were reclassified as fRCRI ≥3. By multivariate logistic regression analysis, fRCRI (odds ratio 1.529, 95% confidence interval 1.035 to 2.258, p = 0.033) and a left ventricular ejection fraction <50% independently predicted in-hospital MACE. In conclusion, fRCRI is an independent predictor of in-hospital MACE in patients undergoing noncardiac vascular surgery.
authors.affiliation: Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Myung Hwan
authors.initials: MH
authors.lastname: Bae
authors.forename: Se Yong
authors.initials: SY
authors.lastname: Jang
authors.forename: Won Suk
authors.initials: WS
authors.lastname: Choi
authors.forename: Kyun Hee
authors.initials: KH
authors.lastname: Kim
authors.forename: Sun Hee
authors.initials: SH
authors.lastname: Park
authors.forename: Jang Hoon
authors.initials: JH
authors.lastname: Lee
authors.forename: Hyung Kee
authors.initials: HK
authors.lastname: Kim
authors.forename: Dong Heon
authors.initials: DH
authors.lastname: Yang
authors.forename: Seung
authors.initials: S
authors.lastname: Huh
authors.forename: Hun Sik
authors.initials: HS
authors.lastname: Park
authors.forename: Yongkeun
authors.initials: Y
authors.lastname: Cho
authors.forename: Shung Chull
authors.initials: SC
authors.lastname: Chae
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology*; D016009:Chi-Square Distribution; D015897:Comorbidity; D004562:Electrocardiography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon; D014656:Vascular Surgical Procedures