title: Cardiac risk assessment, morbidity prediction, and outcome in the vascular intensive care unit.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  This is a retrospective review of prospectively maintained Vascubase and prospectively collected ICU data.
  
  
  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.
authors.affiliation: 1Western Vascular Institute, Department of Vascular and Endovascular Surgery, Galway University Hospital, Newcastle Road, Galway, Ireland.
authors.forename: Mary
authors.initials: M
authors.lastname: Dover
authors.forename: Wael
authors.initials: W
authors.lastname: Tawfick
authors.forename: Niamh
authors.initials: N
authors.lastname: Hynes
authors.forename: Sherif
authors.initials: S
authors.lastname: Sultan
mesh_terms: D000368:Aged; D019540:Area Under Curve; D003324:Coronary Artery Disease / Q000150:complications / Q000628:therapy; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007494:Ireland / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D010343:Patient Admission; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014652:Vascular Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*
keywords: ICU; Lee revised cardiac risk index; coronary artery disease; echocardiogram; risk prediction