A newly reclassified fragmented revised cardiac risk index as a prognostic marker in patients undergoing non-cardiac vascular surgery

Abstract

Background: There was not known regarding the significance of the fragmented QRS complex (fQRS) in patients undergoing vascular surgery classified as high risk procedure for perioperative cardiac events. The aim of this study was to investigate the value of a newly reclassified fragmented Revised Cardiac Risk Index (RCRI) including the fQRS (fRCRI) as predictor for cardiac events in patients undergoing non-cardiac vascular surgery. Methods: A total of 467 consecutive patients (69.4±9.5 years; 403 males) who admitted for non-cardiac vascular surgery were studies. All patients were classified as the RCRI 0, 1, 2, ≥3 group according to the sum of diabetes, renal insufficiency, histories of ischemic heart disease, Congestive Heart Failure (CHF), and cerebrovascular disease and then newly reclassified as fRCRI 0, 1, 2, ≥3 group including the fQRS. Major Adverse Cardiac Event (MACE) was defined as a composite of death, Myocardial Infarction (MI), CHF, and percutaneous coronary intervention (PCI) before non-cardiac vascular surgery. Results: During index hospitalization, MACE developed in 38 (8.1%) patients (death 3, MI 19, CHF 11, and PCI before vascular surgery 5). The fQRS was present in 169 (36.2%) and it was significantly higher in patients with MACE than in those without MACE (63.2% vs. 34.3%, P<0.001). The incidence of the RCRI 0, 1, 2 and ≥3 was 46.9% (n=219), 35.3% (n=165), 12.4% (n=58), and 5.4% (n=25), respectively. When the data for the fRCRI including the fQRS were analyzed, 28 patients (48.3%) belonged to the RCRI 2 were reclassified as the fRCRI ≥3 (Figure 1). In multivariate logistic regression analysis, fRCRI (Odds ratio [OR] 1.529, 95% confidence interval [CI] 1.035-2.258, P=0.033) in addition to left ventricular ejection fraction <50% (OR 2.679, 95% CI 1.102-6.511, P=0.030) was an independent predictor for in-hospital MACE after adjusting for age ≥70 years, current smoking, ST-T wave change, and left ventricular hypertrophy on ECG. Conclusion: A newly reclassified fRCRI including the fQRS is an independent predictor for in-hospital MACE in patients undergoing non-cardiac vascular surgery