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• W2802646355 abstract "We have read with great interest the study by Gualandro et al,1Gualandro D.M. Puelacher C. LuratiBuse G. Llobet G.B. Yu P.C. Cardozo F.A. et al.Prediction of major cardiac events after vascular surgery.J Vasc Surg. 2017; 66: 1826-1835Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar in which the authors have tried to evaluate well-established cardiac indices in patients undergoing vascular surgery procedures. However, some points need to be addressed. First, the authors have evaluated both the Revised Cardiac Risk Index (RCRI) and the Vascular Study Group (VSG) index in a mixed vascular surgery patient population, and they have found a higher observed cardiac event rate compared with the predicted event rate.1Gualandro D.M. Puelacher C. LuratiBuse G. Llobet G.B. Yu P.C. Cardozo F.A. et al.Prediction of major cardiac events after vascular surgery.J Vasc Surg. 2017; 66: 1826-1835Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar This concurs with our previous findings that high-cardiac risk patients as defined by the VSG criteria did not suffer a higher cardiac damage after carotid endarterectomy (CEA) compared with low- and medium-cardiac risk patients.2Galyfos G. Tsioufis C. Theodorou D. Katsaragakis S. Zografos G. Filis K. Cardiac troponin I after carotid endarterectomy in different cardiac risk patients.J Stroke Cerebrovasc Dis. 2015; 24: 711-717Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar Moreover, we have found a high prevalence of myocardial injury (MI) in our series, reaching almost 14%,2Galyfos G. Tsioufis C. Theodorou D. Katsaragakis S. Zografos G. Filis K. Cardiac troponin I after carotid endarterectomy in different cardiac risk patients.J Stroke Cerebrovasc Dis. 2015; 24: 711-717Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar concurring with the results of the authors,1Gualandro D.M. Puelacher C. LuratiBuse G. Llobet G.B. Yu P.C. Cardozo F.A. et al.Prediction of major cardiac events after vascular surgery.J Vasc Surg. 2017; 66: 1826-1835Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar whose MI rate reached almost 8% after CEA. However, as the authors underline, only 24% of their cohort underwent CEA compared with the VSG cohort, in which almost 50% of patients underwent CEA.3Bertges D.J. Goodney P.P. Zhao Y. Schanzer A. Nolan B.W. Likosky D.S. et al.The vascular study Group of New England cardiac risk index (VSG-CRI) predicts cardiac complications more accurately than the revised cardiac risk index in vascular surgery patients.J Vasc Surg. 2010; 52: 674-683Abstract Full Text Full Text PDF PubMed Scopus (167) Google Scholar These data indicate that each procedure may have its own impact on outcomes, and therefore populations with a more uniform distribution of surgery types should be evaluated. Second, the authors found that the VSG index showed a better performance compared with RCRI, although the addition of preoperative anemia increased the performance of the RCRI.1Gualandro D.M. Puelacher C. LuratiBuse G. Llobet G.B. Yu P.C. Cardozo F.A. et al.Prediction of major cardiac events after vascular surgery.J Vasc Surg. 2017; 66: 1826-1835Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar However, as we have highlighted in the past, the RCRI is an index that was developed almost 15 years ago, when the criteria for the detection of MI did not include the more accurate cardiac biomarkers that are used today.4Galyfos G. Aggeli K. Sigala F. Karanikola E. Zografos G. Filis K. Preoperative cardiac assessment before carotid surgery: should perhaps things change?.Ann Vasc Surg. 2016; 30: 331-335Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar Furthermore, a systematic review by Ford et al5Ford M.K. Beattie W.S. Wijeysundera D.N. Systematic review: prediction of perioperative cardiac complications and mortality by the revised cardiac risk index.Ann Intern Med. 2010; 152: 26-35Crossref PubMed Scopus (342) Google Scholar (almost 800,000 patients included) has found a moderate performance of the RCRI in patients undergoing noncardiac surgery, with an even lower performance observed in vascular surgery patients. In addition, Bertges et al6Bertges D.J. Neal D. Schanzer A. Scali S.T. Goodney P.P. Eldrup-Jorgensen J. et al.The Vascular Quality Initiative cardiac risk index for prediction of myocardial infarction after vascular surgery.J Vasc Surg. 2016; 64: 1411-1421Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar have evaluated risk models in a large registry of vascular surgery patients, and they have found that procedure-specific models perform better than all-procedure models. Therefore, optimal risk indices should take into consideration both the type of vascular surgery and other specific perioperative factors, such as serum biomarkers, to improve their performance. Prediction of major cardiac events after vascular surgeryJournal of Vascular SurgeryVol. 66Issue 6PreviewPredicting cardiac events is essential to provide patients with the best medical care and to assess the risk-benefit ratio of surgical procedures. The aim of our study was to evaluate the performance of the Revised Cardiac Risk Index (Lee) and the Vascular Study Group of New England Cardiac Risk Index (VSG) scores for the prediction of major cardiac events in unselected patients undergoing arterial surgery and to determine whether the inclusion of additional risk factors improved their accuracy. Full-Text PDF Open ArchiveReplyJournal of Vascular SurgeryVol. 67Issue 5PreviewWe thank Dr Galyfos and Dr Filis for their interest in our publication addressing cardiac risk estimation in vascular surgery and for their important remarks. First, we agree that each specific procedure has a particular impact on cardiac risk, that this could interfere with the accuracy of the risk scores, and that procedure-specific models, such as those developed by Bertges et al,1 may perform better. However, in a recent study, Moses et al compared and validated the Revised Cardiac Risk Index, the risk calculator of the American College of Surgeons National Surgical Quality Improvement Program, and the Vascular Study Group of New England Cardiac Risk Index in a retrospective database of 856 patients. Full-Text PDF Open Archive" @default.
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• W2802646355 title "Regarding “Prediction of major cardiac events after vascular surgery”" @default.
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