MAJOR VASCULAR SURGERY IN THE GERIATRIC POPULATION: CARDIAC RISK STRATIFICATION
Abstract
Reliance on surgery, improvements in surgical techniques, and perioperative management have led to a dramatic increase in the frequency of surgical procedures in the elderly population. According to the European Society of Cardiology and the European Society of Anaesthesiology and Intensive Care, major vascular surgery is defined as high-risk, considering the frequency of myocardial infarction and cardiac arrest, which is higher than 5%. Age is an independent predictor of myocardial infarction and cardiac arrest. Heart function alterations are primary changes that occur with advancing age. Risk stratification represents a set of procedures that include identifying chronic systemic diseases, determining their severity, stability and the need for further evaluation and/or therapy optimization, with the aim of reducing perioperative and postoperative mortality and morbidity. In addition to the application of risk scores, accurate risk stratification requires the combined application of both preoperative and postoperative biomarkers. The main idea of integrating biomarkers with scoring systems is to reveal those patients with clinically unmanifested disease, who carry a mortality risk and remain undetected by scoring systems. Biomarkers, such as NT-proBNP and highly sensitive C-reactive protein, have the greatest predictive influence in geriatric vascular surgery.
References
Vincent GK, Velkoff VA. The Next Four Decades: The Older Population in the United States: 2010 to 2050. Washington, DC: US Department of Commerce, Economics and Statistics Administration, US Census Bureau; 2010.
Mangano DT. Perioperative medicine: NHLBI working group deliberations and recommendations. J Cardiothorac Vasc Anesth. 2004 Feb;18(1):1-6. doi: 10.1053/j.jvca.2003.10.002.
Kristensen SD, Knuuti J, Saraste A, Anker S, Bøtker HE, De Hert S, et al.; Authors/Task Force Members. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur J Anaesthesiol. 2014 Oct;31(10):517-73. doi: 10.1097/EJA.0000000000000150.
Hertzer NR, Beven EG, Young JR, O'Hara PJ, Ruschhaupt WF 3rd, Graor RA, et al. Coronary artery disease in peripheral vascular patients. A classification of 1000 coronary angiograms and results of surgical management. Ann Surg. 1984 Feb;199(2):223-33. doi: 10.1097/00000658-198402000-00016.
Priebe HJ. The aged cardiovascular risk patient. Br J Anaesth [Internet]. 2000;85(5):763-78. Dostupno na: http://www.ncbi.nlm.nih.gov/pubmed/11094595
Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, et al. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev. 2011 Sep;10(4):430-9. doi: 10.1016/j.arr.2011.03.003.
Schwarze ML, Barnato AE, Rathouz PJ, Zhao Q, Neuman HB, Winslow ER, et al. Development of a list of high-risk operations for patients 65 years and older. JAMA Surg. 2015 Apr;150(4):325-31. doi: 10.1001/jamasurg.2014.1819.
Perić VS, Golubović MD, Lazarević MV, Kostić TL, Stokanović DS, Đorđević MN, et al. Predictive potential of biomarkers and risk scores for major adverse cardiac events in elderly patients undergoing major elective vascular surgery. Rev Cardiovasc Med. 2021 Sep 24;22(3):1053-1062. doi: 10.31083/j.rcm2203115.
QxMD. Geriatric-Sensitive Perioperative Cardiac Risk Index| GSCRI: Estimate risk of perioperative myocardial infarction or cardiac arrest in patients over 65. [Internet]. 2015. Dostupno na: https://qxmd.com/calculate/calculator_448/geriatric-sensitive-perioperative-cardiac-risk-index-gscri.
Prytherch DR, Ridler BM, Beard JD, Earnshaw JJ. A model for national outcome audit in vascular surgery. [Internet]. Eur J Vasc Endovasc Surg 2001; 21(6):477-83. Dostupno na: http://www.riskprediction.org.uk/disclaimer.php.
Goldman L. Revised Cardiac Risk Index for Pre-Operative Risk: Estimates risk of cardiac complications after noncardiac surgery. [Internet]. 2019. Dostupno na: https://www.mdcalc.com/revised-cardiac-risk-index-pre-operative-risk.
Gupta KP. Gupta Perioperative Risk for Myocardial Infarction or Cardiac Arrest (MICA): Predicts risk of MI or cardiac arrest after surgery. [Internet]. 2018. Dostupno na: https://www.mdcalc.com/gupta-perioperative-risk-myocardial-infarction-cardiac-arrest-mica.
Golubović M, Perić V, Lazarević M, Jovanović N, Marjanović V, Stošic B, et al. Estimation of postoperative cardiac complications with V-POSSUM model in patients prepared for major elective vascular surgery. Acta Medica Medianae 2019;58(1):39-43.
Perić V, Golubović M, Lazarević M, Kostić T, Stokanović D, Djordjević M, et al. Correlation of clinical and demographic factors with occurrence of myocardial infarction and cardiac arrest in older patients after major elective vascular surgery. Acta Medica Medianae. 2022;61(3):14-9. doi:10.5633/amm.2022.0302.
Golubovic M, Peric V, Stanojevic D, Lazarevic M, Jovanovic N, Ilic N, et al. Potential New Approaches in Predicting Adverse Cardiac Events One Month after Major Vascular Surgery. Med Princ Pract. 2019;28(1):63-69. doi: 10.1159/000495079.
Biccard BM, Rodseth RN. Utility of clinical risk predictors for preoperative cardiovascular risk prediction. Br J Anaesth. 2011 Aug;107(2):133-43. doi: 10.1093/bja/aer194.
Golubovic M, Stanojevic D, Lazarevic M, Peric V, Kostic T, Djordjevic M, et al. A Risk Stratification Model for Cardiovascular Complications during the 3-Month Period after Major Elective Vascular Surgery. Biomed Res Int. 2018 Sep 9;2018:4381527. doi: 10.1155/2018/4381527.
Gottdiener JS, Arnold AM, Aurigemma GP, Polak JF, Tracy RP, Kitzman DW, et al. Predictors of congestive heart failure in the elderly: the Cardiovascular Health Study. J Am Coll Cardiol. 2000 May;35(6):1628-37. doi: 10.1016/s0735-1097(00)00582-9.
Riehle C, Bauersachs J. Key inflammatory mechanisms underlying heart failure. Herz. 2019 Apr;44(2):96-106. doi: 10.1007/s00059-019-4785-8.
Bauer SM, Cayne NS, Veith FJ. New developments in the preoperative evaluation and perioperative management of coronary artery disease in patients undergoing vascular surgery. J Vasc Surg. 2010 Jan;51(1):242-51. doi: 10.1016/j.jvs.2009.08.087.
McKechnie DG, Papacosta AO, Lennon LT, Welsh P, Whincup PH, Wannamethee SG. Inflammatory markers and incident heart failure in older men: the role of NT-proBNP. Biomark Med. 2021 Apr;15(6):413-425. doi: 10.2217/bmm-2020-0669.
