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Abdominal Aortic Aneurysm Surgery Risk Index for Cardiac Event

Purpose: To evaluate a patient for perioperative cardiac risk prior to vascular surgery using the risk index of Vanzetto et al.

Description

Vanzetto et al identified risk factors for a perioperative cardiac event in a patient having repair of an abdominal aortic aneurysm. This can help identify patients who may benefit from additional cardiac testing and/or cardiac revascularization prior to surgery. The authors are from Centre Hospitalier Universitaire, Grenoble-Cedex, France.


Risk factors:

(1) age

(2) history of angina

(3) history of myocardial infarction (MI)

(4) history of congestive heart failure (CHF)

(5) diabetes mellitus

(6) severe hypertension (hypertension with severe left ventricular hypertrophy)

(7) Q waves on ECG

(8) ST segment abnormalities on resting ECG

 

Parameter

Finding

Points

age

> 70 years of age

1

 

<= 70 years of age

0

history of angina

present

1

 

absent

0

history of myocardial infarction

present

1

 

absent

0

history of congestive heart failure

present

1

 

absent

0

diabetes mellitus

present

1

 

absent

0

hypertension

severe

1

 

mild to moderate

0

 

none

0

Q waves on ECG

present

1

 

absent

0

ST segment changes on resting ECG

present

1

 

absent

0

 

risk index =

= SUM(points for all 8 parameters)

 

Interpretation:

• minimum index: 0

• maximum index: 8

• The higher the index the higher the risk of a perioperative cardiac event.

 

Risk Index

Post-Test Probability

0

2

1

4

2, 3 or 4

4

5, 6, 7 or 8

16

from Table 2, page 319, Palda and Detsky (1997)

 

In addition, the authors reported that coronary angiography was indicated if SPECT (single photon emission computed tomography) imaging of the heart showed either:

(1) reversible defect anywhere (especially if more than 1 abnormal segment identified)

(2) a large defect on the anterior wall.


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Specialty

Objective

ICD-10