IMR Press / RCM / Volume 22 / Issue 3 / DOI: 10.31083/j.rcm2203115
Open Access Original Research
Predictive potential of biomarkers and risk scores for major adverse cardiac events in elderly patients undergoing major elective vascular surgery
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1 Clinic of Cardiovascular Surgery, Clinical Center Nis, 18000 Nis, Serbia
2 Medical School of Nis, University of Nis, 18000 Nis, Serbia
3 Clinic for Cardiology, Clinical Center Nis, 18000 Nis, Serbia
4 Clinic for Endocrine Surgery, Clinical Center Nis, 18000 Nis, Serbia
5 Clinic for Anesthesiology and Intensive Therapy, Clinical Center Nis, 18000 Nis, Serbia
Academic Editor: Carmela Rita Balistreri
Rev. Cardiovasc. Med. 2021, 22(3), 1053–1062; https://doi.org/10.31083/j.rcm2203115
Submitted: 14 July 2021 | Revised: 5 August 2021 | Accepted: 27 August 2021 | Published: 24 September 2021
(This article belongs to the Special Issue New Frontiers in Cardiac Surgery: Biomarkers and Treatment)
Abstract

Elderly patients scheduled for major elective vascular surgery are at high risk for a major adverse cardiac events (MACE). The objectives of the study were: (1) To determine the individual discriminatory ability of four risk prediction models and four biomarkers in predicting MACEs in elderly patients undergoing major elective vascular surgery; (2) to find a prognostic model with the best characteristics; (3) to examine the significance of all preoperative parameters; and (4) to determine optimal cut-off values for biomarkers with best predictor capabilities. We enrolled 144 geriatric patients, aged 69.97 ± 3.73 years, with a 2:1 male to female ratio. Essential inclusion criteria were open major vascular surgery and age >65 years. The primary outcome was the appearance of MACEs within 6 months. These were noted in 33 (22.9%) patients. The most frequent cardiac event was decompensated heart failure, which occurred in 22 patients (15.3%). New onset atrial fibrillation was registered in 13 patients (9%), and both myocardial infarction and ventricular arrhythmias occurred in eight patients each (5.5%). Excellent discriminatory ability (AUC >0.8) was observed for all biomarker combinations that included the N-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP). The most predictive two-variable combination was the Geriatric-Sensitive Cardiac Risk Index (GSCRI) + NT-proBNP (AUC of 0.830 with a 95% confidence interval). Female gender, previous coronary artery disease, and NT-proBNP were three independent predictors in a multivariate model of binary logistic regression. The Cox regression multivariate model identified high-sensitivity C-reactive protein and NT-proBNP as the only two independent predictors.

Keywords
Biomarker
Risk score
Elderly
Vascular surgery
MACE
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