Estimation of individual perioperative cardiac risk in patients with tumors of the head and neck with documented ischemic heart disease
DOI:
https://doi.org/10.14739/2310-1210.2013.6.20784Keywords:
individual perioperative risk, head and neck tumors, coronary heart diseaseAbstract
Background: Approximately half of all deaths in non-cardiac surgery is associated with cardiovascular complications. Expedient to constantly improve existing stratification model to identify the most powerful predictors that can be used to objectively assess the risk of cardiovascular complications before elective surgery.
Material and methods.
The study included 109 patients with malignant neoplasms of the head and neck with concomitant coronary artery disease, aged 38 to 78 years (mean age 60,17 ± 0,78 years): 39 (35.8%) males and 70 (64.2% ) women. The vast majority of patients (60 persons (55.0%)) had thyroid cancer. Before surgery, all patients have ECG at rest, a two-dimensional echocardiography, determined the number of red blood cells in the peripheral blood, hemoglobin and hematocrit, fasting glucose, fibrinogen, plasma creatinine, calculated GFR by Cockcroft-Gault and MDRD (Modification of Diet in Renal Disease Study), investigated paired troponins I. On the day of surgery all patients underwent ECG monitoring. To identify predictors of adverse CHD during surgical interventions used Cox proportional hazards models.
Results. New criteria for evaluation of individual perioperative risk in the performance of interventions for head and neck tumors include: body mass index less than 22.79 kg/m2, height168 cm more, the minute volume of blood is less than 5.027 l/min, hematocrit greater than 0.46 l/l, GFR (MDRD) less than 75 ml/min, the duration of ST-segment elevation more than 39 minutes per day and maximum ST segment elevation more than 139 mV in patients with documentedischemic heart disease.
Сonclutions. Consideration of these parameters allows to identify a cohort of patients with proven coronary artery disease patients with high risk of cardiovascular complications in non-cardiac surgical interventions moderate surgical risk for tumors of the head and neck.
References
ASA Physical Status Classifi cation System [Електронний
ресурс]. – Available from: http://www.asahq.org/clinicalinfo.
htm.
Cockcroft D.W. Prediction of creatinine clearance from serum creatinine / D.W. Cockcroft, M.H. Gault // Nephron. – 1976. – Vol. 16. – P. 31–41.
Gupta P.K. Development and validation of a risk calculator for prediction of cardiac risk after surgery / P.K. Gupta, H. Gupta, A. Sundaram et al. // Circulation. – 2011. – Vol. 124(4). – P. 381–387.
Halm E.A. Echocardiography for assessing cardiac risk in
patients having noncardiac surgery. Study of Perioperative
Ischemia Research Group [published correction appears in Ann. Intern. Med. 1997. – Vol. 126. –P. 494] / E.A. Halm,
W.S. Browner, J.F. Tubau et al. // Ann. Intern. Med. –1996. –
Vol. 125. – P. 433–441.
Levey A.S. Amore accurate method to estimate glomerular
fi ltration rate from serum creatinine: a new prediction equation. Modifi cation of Diet in Renal Disease Study Group /
A.S. Levey, J.P. Bosch, J.B. Lewis et al. // Ann. Intern. Med.
– 1999. – Vol. 130. – P. 461–470.
Mangano D. Perioperative cardiac morbidity / D. Mangano // Anesthesiology. – 1990. – Vol. 72. – Р. 153–184.
Poldermans D. Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery The Task Force for Preoperative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-cardiac Surgery of the European Society of Cardiology (ESC) and endorsed by the European Society of Anaesthesiology (ESA) / D. Poldermans, J. Bax J., E. Boersma et al. // Eur. Heart J. – 2009. – doi:10.1093/eurheartj/ehp337.
Wu W.C. Preoperative hematocrit levels and postoperative outcomes in older patients undergoing noncardiac surgery / W.C. Wu, T.L. Schifftner, W.G. Henderson et al. // JAMA. – 2007. – Vol. 297. – P. 2481–2488.
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