Boersma et al developed two models for predicting the risk of a serious cardiac event during or after major vascular surgery with and without beta blocker therapy. The first model includes dobutamine stress echocardiography in all patients. This can help identify patients who should be considered for cardiac revascularization. The authors are from the DECREASE (Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography) Study Group in the Netherlands and Italy.
Vascular surgery was performed for serious peripheral vascular disease or aortic aneurysms.
Cardiac endpoint: postoperative 30 day cardiac death or acute myocardial infarction
Parameters:
(1) cardiac risk index
(2) findings on dobutamine stress echocardiography (DSE)
(3) use of beta-blockers
Cardiac risk index parameters:
(1) age
(2) angina
(3) history of myocardial infarction
(4) congestive heart failure
(5) history of cerebrovascular event
(6) diabetes mellitus
(7) renal failure
|
Cardiac Risk Index Parameters |
Finding |
Points |
|
age in years |
< 70 years |
0 |
|
|
>= 70 years |
1 |
|
angina |
absent |
0 |
|
|
present |
1 |
|
history of myocardial infarction |
absent |
0 |
|
|
present |
1 |
|
congestive heart failure |
absent |
0 |
|
|
present |
1 |
|
history of cerebrovascular event |
absent |
0 |
|
|
present |
1 |
|
diabetes mellitus |
absent |
0 |
|
|
present |
1 |
|
renal failure |
absent |
0 |
|
|
present |
1 |
total risk score =
= SUM(points for all 7 parameters)
Findings on dobutamine stress echocardiography (DSE):
(1) not known or considered
(2) no new wall motion abnormalities
(3) new wall motion abnormalities
No DSE Data
|
Risk Score |
No Beta Blockers Used |
Beta Blockers Used |
|
0 |
1.0% |
0.4% |
|
1 |
2.2% |
0.8% |
|
2 |
4.5% |
1.6% |
|
3 |
9.2% |
3.4% |
|
4 |
18% |
7.0% |
|
>= 5 |
32% |
14.0% |
No New Wall Motion Abnormalities on DSE
|
Risk Score |
No Beta Blockers Used |
Beta Blockers Used |
|
0 |
0.8% |
0.1% |
|
1 |
1.4% |
0.2% |
|
2 |
2.3% |
0.3% |
|
3 |
3.7% |
0.4% |
|
4 |
8.1% |
0.7% |
|
>= 5 |
9.8% |
1.2% |
New Wall Motion Abnormalities on DSE
|
Risk Score |
No Beta Blockers Used |
Beta Blockers Used |
|
0 |
11% |
1.5% |
|
1 |
18% |
2.4% |
|
2 |
26% |
4.0% |
|
3 |
38% |
6.5% |
|
4 |
50% |
10% |
|
>= 5 |
63% |
16% |
Specialty: Cardiology, Surgery, general
ICD-10: ,
