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Lee's revised cardiac risk assessment

J F Mooney, G S Hillis, V W Lee, R Halliwell, M Vicaretti, C Moncrieff, C K Chow
BACKGROUND: Increasingly, patients undergoing non-cardiac surgery are older and have more comorbidities yet preoperative cardiac assessment appears haphazard and unsystematic. We hypothesised that patients at high cardiac risk were not receiving adequate cardiac assessment, and patients with low-cardiac risk were being over-investigated. AIMS: To compare in a representative sample of patients undergoing non-cardiac surgery the use of cardiac investigations in patients at high and low preoperative cardiac risk...
August 2016: Internal Medicine Journal
Michael H Gewitz, Robert S Baltimore, Lloyd Y Tani, Craig A Sable, Stanford T Shulman, Jonathan Carapetis, Bo Remenyi, Kathryn A Taubert, Ann F Bolger, Lee Beerman, Bongani M Mayosi, Andrea Beaton, Natesa G Pandian, Edward L Kaplan
BACKGROUND: Acute rheumatic fever remains a serious healthcare concern for the majority of the world's population despite its decline in incidence in Europe and North America. The goal of this statement was to review the historic Jones criteria used to diagnose acute rheumatic fever in the context of the current epidemiology of the disease and to update those criteria to also take into account recent evidence supporting the use of Doppler echocardiography in the diagnosis of carditis as a major manifestation of acute rheumatic fever...
May 19, 2015: Circulation
Ji-won Hwang, Eun-Kyung Kim, Jung-Hoon Yang, Sung-A Chang, Young Bin Song, Joo-Yong Hahn, Seung Hyuk Choi, Hyeon-Cheol Gwon, Sang-Hoon Lee, Sung-Mok Kim, Yeon Hyeon Choe, Jae K Oh, Jin-Ho Choi
BACKGROUND: The appropriate indication for coronary computed tomographic angiography (CTA) as a part of preoperative evaluation has not been defined yet. We investigated the value of coronary CTA in patients undergoing noncardiac surgery. METHODS AND RESULTS: We included 844 patients (median age, 67 years; male sex, 62%) who underwent coronary CTA for screening of coronary artery disease before noncardiac surgery. Clinically determined revised cardiac risk index were compared with the extent and severity of coronary artery disease assessed by coronary CTA...
March 2015: Circulation. Cardiovascular Imaging
Raoul Borioni, Fabrizio Tomai, Alessio Pederzoli, Laura Fratticci, Filippo Barberi, Leonardo De Luca, Marzia Albano, Mariano Garofalo
BACKGROUND: Current guidelines do not recommend routine coronary evaluation preceding abdominal aortic aneurysms (AAA) repair in low-risk patients. The purpose of the present study is to report the incidence of coronary lesions in candidates for AAA repair with a Revised Cardiac Risk (Lee) Index (RCRI) < 2, which are usually excluded from preoperative cardiological work-up. Early-term and long-term results of prophylactic myocardial revascularization are also reported. METHODS: A retrospective, observational, cohort study collecting clinical data on a series of 149 consecutive patients undergoing preoperative coronary angiography and myocardial revascularization (percutaneous coronary intervention, PCI; coronary artery bypass grafting, CABG) before elective open or endovascular AAA repair (January 2005-December 2012)...
November 2014: Journal of Cardiovascular Medicine
Ali Seifi, Kevin Carr, Mitchell Maltenfort, Michael Moussouttas, Lee Birnbaum, Augusto Parra, Owoicho Adogwa, Rodney Bell, Fred Rincon
OBJECTIVES: To determine the association between myocardial infarction (AMI) and clinical outcome in patients with primary admissions diagnosis of acute cerebral ischemia (ACI) in the US. METHODS: Data from Nationwide Inpatient Sample (NIS) was queried from 2002-2011 for inpatient admissions of patients with a primary diagnosis of ACI with and without AMI using International Classification of Diseases, Ninth Revision, Clinical Modification coding (ICD-9). A multivariate stepwise regression analysis was performed to assess the correlation between identifiable risk factors and clinical outcomes...
2014: PloS One
Hans-Jörg Gillmann, Antje Meinders, Anika Grohennig, Jan Larmann, Christoph Bünte, Simone Calmer, Bianca Sahlmann, Saad Rustum, Thomas Aper, Ralf Lichtinghagen, Armin Koch, Omke E Teebken, Gregor Theilmeier
OBJECTIVES: Myocardial infarction after major surgery is frequent, drives outcome, and consumes health resources. Specific prediction and detection of perioperative myocardial infarction is an unmet clinical need. With the widespread use of high-sensitive cardiac troponin T assays, positive tests become frequent, but their diagnostic or prognostic impact is arguable. We, therefore, studied the association of routinely determined pre- and postoperative high-sensitive cardiac troponin T with the occurrence of major adverse cardiac events...
June 2014: Critical Care Medicine
Sreyram Kuy, Anahita Dua, Sapan S Desai, Peter J Rossi, Gary R Seabrook, Brian D Lewis, Bhavin Patel, Sreyreath Kuy, Cheong J Lee, Rishi Subbarayan, Kellie R Brown
BACKGROUND: The objective was to evaluate the difference in timing (if any) of in-hospital carotid endarterectomy (CEA) or outcomes of CEA based on sex among men and women hospitalized for carotid artery disease. METHODS: This was a retrospective cross-sectional study using the Nationwide Inpatient Sample Database. All patients from 2000-2009 who underwent CEA during their hospitalization were examined. International Classification of Diseases, 9th revision codes were used to identify patients who underwent CEA during hospitalization, stratify asymptomatic and symptomatic patients, determine time in days from admission to CEA, and examine in-hospital complications, including perioperative stroke, cardiac events, and death...
May 2014: Annals of Vascular Surgery
Mary Dover, Wael Tawfick, Niamh Hynes, Sherif Sultan
OBJECTIVES: 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. DESIGN: This is a retrospective review of prospectively maintained Vascubase and prospectively collected ICU data. MATERIALS AND METHODS: Data from 363 consecutive vascular ICU admissions were collected...
November 2013: Vascular and Endovascular Surgery
Nir Hoftman, Adrian Prunean, Anahat Dhillon, Gabriel M Danovitch, Michael S Lee, Hans Albin Gritsch
BACKGROUND: We evaluated a published Revised Cardiac Risk Index (RCRI) to determine if this preoperative cardiovascular risk stratification tool would be useful in the kidney transplant recipient population. METHODS: We identified all kidney transplants from 2005 to 2009 (n=1652) at our institution. We performed a detailed retrospective chart review of (a) all recipients who underwent preoperative coronary angiography (n=169) and (b) an age-matched and transplantation year-matched group who did not undergo coronary angiography (n=156)...
October 15, 2013: Transplantation
Myung Hwan Bae, Se Yong Jang, Won Suk Choi, Kyun Hee Kim, Sun Hee Park, Jang Hoon Lee, Hyung Kee Kim, Dong Heon Yang, Seung Huh, Hun Sik Park, Yongkeun Cho, Shung Chull Chae
The aim of this study was to investigate the value of a new Revised Cardiac Risk Index (RCRI) that includes consideration of QRS fragmentation (fQRS) as a predictor of cardiac events in patients undergoing noncardiac vascular surgery. Four hundred sixty-seven consecutive patients admitted for noncardiac vascular surgery were studied. Patients were allocated to RCRI 0, 1, 2, or ≥3 groups according to the sum of diabetes, renal insufficiency, and histories of ischemic heart disease, congestive heart failure, and cerebrovascular disease...
July 1, 2013: American Journal of Cardiology
Duminda N Wijeysundera, Muhammad Mamdani, Andreas Laupacis, Lee A Fleisher, W Scott Beattie, Sindhu R Johnson, Jonathan Kolstad, Mark D Neuman
BACKGROUND: Largely on the basis of 2 randomized trials published in the 1990s, β-blockers were initially promoted as an evidence-based intervention for preventing cardiac complications of noncardiac surgery. However, subsequent studies raised concerns about a widespread use of perioperative β-blockade. Little is known regarding how this changing evidence influenced the use of perioperative β-blockers in clinical practice. METHODS AND RESULTS: We conducted a population-based, time-series analysis (April 1999 to March 2010) among residents of Ontario, Canada (age 66 years and older), to evaluate the influence of research publications and practice guidelines on rates of new β-blocker prescriptions before major elective noncardiac surgery...
July 1, 2012: Circulation. Cardiovascular Quality and Outcomes
Jayakeerthi Y Rao, M C Yeriswamy, M J Santhosh, Gurappa G Shetty, Kiron Varghese, Chandrakant B Patil, Shamanna S Iyengar
OBJECTIVE: The revised cardiac risk index (RCRI/Lee's score) was designed for peri-operative risk assessment before elective major non-cardiac surgeries. Through this article, we report the usefulness of RCRI in our daily practice, while evaluating patients undergoing surgeries of varying risk. METHODS: Only referred patients, aged ≥ 40 years, were included. Risk stratification was done using RCRI scoring system. Patients were categorised into 4 classes depending on 0, 1, 2, and ≥3 risk predictors (risk predictors were high-risk surgery, history of ischaemic heart disease (IHD), diabetes on insulin, history of stroke (cerebrovascular accident [CVA]), history of congestive heart failure (CHF) and serum creatinine of >2 mg%)...
March 2012: Indian Heart Journal
Michael Mazzeffi, Brigid Flynn, Carol Bodian, David Bronheim
BACKGROUND: Arterial pulse pressure hypertension is associated with perioperative morbidity and mortality in cardiac surgery patients. However, its association with perioperative mortality in other high-risk surgical populations has not been determined. In this study, we tested the hypothesis that increased preoperative arterial pulse pressure is associated with 30-day and 1-year all-cause mortality after lower extremity arterial bypass surgery. METHODS: A retrospective review of patients who had infrainguinal arterial bypass surgery at a single center over a 6-year period (January 2002 to January 2008) was performed (n = 556)...
June 2012: Anesthesia and Analgesia
Sung Eun Kim, Dae-Gyun Park, Jun Hee Lee, Kyoo Rok Han, Dong Jin Oh
BACKGROUND AND OBJECTIVES: Patients without previous history of cardiac disease can be regarded as low-risk when undergoing major non-cardiac surgery. The aim of this study was to examine whether preoperative B-type natriuretic peptide (BNP) level predicted postoperative cardiac events in these patients. SUBJECTS AND METHODS: Preoperative BNP level was measured in 163 patients whose risk was considered low according to the Revised Cardiac Risk Index. Postoperative cardiac events, including death during hospitalization, myocardial injury, arrhythmia, cerebrovascular accidents and congestive heart failure were assessed...
January 2011: Korean Circulation Journal
Balachundhar Subramaniam, Yuval Meroz, Daniel Talmor, Frank B Pomposelli, Yaacov Berlatzky, Giora Landesberg
BACKGROUND: In a previous study it has been shown that a long-term survival score (LTSS), composed of Lee's Revised Cardiac Risk Index (RCRI) criteria supplemented by age, preoperative electrocardiography (EKG) features, and all types of diabetes to the RCRI criteria, predicts long-term (3-15 years) survival after major vascular surgery. The present study aimed to investigate the performance of LTSS in predicting earlier survival (3 months-3 years) as compared with the RCRI. METHODS: Data from 921 consecutive patients undergoing major vascular surgery (624 patients at Hadassah Medical Center [HMC] and 296 patients in Beth Israel Deaconess Medical Center [BIDMC]) were collected retrospectively...
February 2011: Annals of Vascular Surgery
Sarah Barnett, Suneetha Ramani Moonesinghe
Perioperative morbidity is associated with reduced long term survival. Comorbid disease, cardiovascular illness, and functional capacity can predispose patients to adverse surgical outcomes. Accurate risk stratification would facilitate informed patient consent and identify those individuals who may benefit from specific perioperative interventions. The ideal clinical risk scoring system would be objective, accurate, economical, simple to perform, based entirely on information available preoperatively, and suitable for patients undergoing both elective and emergency surgery...
August 2011: Postgraduate Medical Journal
Lee Goldman
No abstract text is available yet for this article.
January 5, 2010: Annals of Internal Medicine
J-H Choi, D K Cho, Y-B Song, J-Y Hahn, S Choi, H-C Gwon, D-K Kim, S H Lee, J K Oh, E-S Jeon
OBJECTIVE: To investigate whether simple and non-invasive measurement of N-terminal pro-brain natriuretic peptide (NT-proBNP) and/or C-reactive protein (CRP) can predict perioperative major cardiovascular event (PMCE). DESIGN: Prospective, single-centre, cohort study. SETTING: A 1900-bed tertiary-care university hospital in Seoul, Korea Design and PATIENTS: The predictive power of NT-proBNP, CRP and Revised Cardiac Risk Index (RCRI) for the risk of PMCE (myocardial infarction, pulmonary oedema or cardiovascular death) were evaluated from a prospective cohort of 2054 elective major non-cardiac surgery patients...
January 2010: Heart: Official Journal of the British Cardiac Society
W-J Flu, J-P van Kuijk, M T Voûte, R Kuiper, H J M Verhagen, J J Bax, D Poldermans
OBJECTIVES: This study evaluated the prognostic value of asymptomatic low ankle-brachial index (ABI) to predict perioperative myocardial damage, incremental to conventional cardiac risk factors imbedded in cardiac risk indices (Revised Cardiac index and Adapted Lee index). MATERIALS AND METHODS: Preoperative ABI measurements were performed in 627 consecutive vascular surgery patients (carotid artery or abdominal aortic aneurysm repair). An ABI<0.90 was considered abnormal...
January 2010: European Journal of Vascular and Endovascular Surgery
Sylvia Archan, Christopher R Roscher, Ronald M Fairman, Lee A Fleisher
OBJECTIVE: To determine if the Revised Cardiac Risk Index (Lee) is useful for stratification of patients by risk of both perioperative cardiac morbidity and long-term all-cause mortality in the setting of endovascular repair of abdominal aortic aneurysms. DESIGN: This study was designed as a retrospective review. SETTING: It was conducted at a single academic medical institution. PARTICIPANTS: The analysis included 225 patients with abdominal aortic aneurysms admitted to the authors' institution from 1999 to 2006...
February 2010: Journal of Cardiothoracic and Vascular Anesthesia
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