Abstract PR046: The Revised Cardiac Risk Index Or the Vascular Study Group of New England Cardiac Risk Index in Patients Undergoing Carotid Endarterectomy?

Background & Objectives: Currently, the most commonly used model to predict cardiac risk before non-cardiac or vascular surgery is the Revised Cardiac Risk Index (RCRI), but some studies have pointed out that the Vascular Study Group of New England Cardiac Risk Index (VSG-CRI) is a better predictor of cardiac complications. The objective of this study was to assess which index indicates intraoperative hemodynamics instability (IHI) and a higher incidence of following comorbidities (FC). Materials & Methods: The medical records of 101 patients, underwent carotid endarterectomy under cervical plexus block during a 3 month period at our institution, were retrospectively reviewed. RCRI and VSG-CRI were used to classify patients into 3 groups: low (I), medium (II) and high risk group (III). IHI was defined as an increase/decrease in systolic and diastolic blood pressure or heart rate for ≥20% from basal value, for 2 minutes. The incidence of FC such as insulin-dependent diabetes mellitus (IDDM), chronic heart failure (CHF), coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), old age and smoking, were compared among groups. Results: According to RCRI, group I consisted of 26 patients (25.74%), group II of 68 (67.33%) and group III of 7 (6.93%). On the other hand, according to VSG-CRI, group I consisted of 52 patients (51.49%), group II of 35 (36.63%) and group III of 12 (11.88%). No statistically significant differences in blood pressure alterations (systolic and diastolic) and heart rate were noted among groups classified by the RCRI and VSG-CRI. The incidence of IDDM, CHF and CAD were significantly higher in III group compared to the other two groups classified by RCRI (p=0.004, p=0.005, p=0.0001, respectively). In line with VSG-CRI, age and the incidence of CHF and CAD were significantly higher in group III compared to the other two groups (p<0,0001, p<0.0001). The incidence of COPD and smoking were statistically higher in the medium group compared to the other two groups, in accordance to VSG-CRI as well (p=0,008, p=0.03). Conclusion: VSG-CRI showed greater representation of the incidences of FC in high (3 FC) and medium risk group (2 FC), compared to RCRI which showed the presence of the only 3 FC in high risk group. Follow-up is necessary to confirm better predictive value of VSG-CRI. References: Bertges DJ, Goodney PP, Zhao Y et al. The Vascular Study Group of New England Cardiac Risk Index predicts cardiac complications more accurately than the Revised Cardiac Risk Index in vascular surgery patients. J Vasc Surg. 2010 Sep;52(3):674–83. Disclosure of Interest: None declared