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Titolo:
DEVELOPMENT AND VALIDATION OF A BAYESIAN MODEL FOR PERIOPERATIVE CARDIAC RISK ASSESSMENT IN A COHORT OF 1,081 VASCULAR SURGICAL CANDIDATES
Autore:
LITALIEN GJ; PAUL SD; HENDEL RC; LEPPO JA; COHEN MC; FLEISHER LA; BROWN KA; ZARICH SW; CAMBRIA RP; CUTLER BS; EAGLE KA;
Indirizzi:
MASSACHUSETTS GEN HOSP,VASC UNIT,DEPT SURG,WANG ACC 458,15 PARKMAN STBOSTON MA 02114 MASSACHUSETTS GEN HOSP,DEPT MED,CARDIAC UNIT BOSTON MA 02114 HARVARD UNIV,SCH MED CAMBRIDGE MA 00000 UNIV MASSACHUSETTS,MED CTR,DEPT NUCL MED WORCESTER MA 00000 UNIV MASSACHUSETTS,MED CTR,DEPT VASC SURG WORCESTER MA 00000 NORTHWESTERN UNIV,DIV CARDIOL CHICAGO IL 60611 NORTHWESTERN UNIV,DIV CRIT CARE CHICAGO IL 60611 DEACONESS HOSP,DIV CARDIOVASC BOSTON MA 00000 DEACONESS HOSP,INST PREVENT CARDIOVASC DIS BOSTON MA 00000 JOHNS HOPKINS UNIV,DEPT ANESTHESIOL BALTIMORE MD 00000 UNIV VERMONT,COLL MED,CARDIOL UNIT BURLINGTON VT 00000 UNIV MICHIGAN,MED CTR,HEART CARE PROGRAM ANN ARBOR MI 00000
Titolo Testata:
Journal of the American College of Cardiology
fascicolo: 4, volume: 27, anno: 1996,
pagine: 779 - 786
SICI:
0735-1097(1996)27:4<779:DAVOAB>2.0.ZU;2-O
Fonte:
ISI
Lingua:
ENG
Soggetto:
CORONARY-ARTERY DISEASE; DIPYRIDAMOLE-THALLIUM SCINTIGRAPHY; MYOCARDIAL-INFARCTION; LOGISTIC-REGRESSION; NONCARDIAC SURGERY; LIKELIHOOD RATIOS; CAROTID ENDARTERECTOMY; PROGNOSTIC VALUE; PREDICTIVE VALUE; MORBIDITY;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
46
Recensione:
Indirizzi per estratti:
Citazione:
G.J. Litalien et al., "DEVELOPMENT AND VALIDATION OF A BAYESIAN MODEL FOR PERIOPERATIVE CARDIAC RISK ASSESSMENT IN A COHORT OF 1,081 VASCULAR SURGICAL CANDIDATES", Journal of the American College of Cardiology, 27(4), 1996, pp. 779-786

Abstract

Objectives. This study sought to develop and validate a Bayesian riskprediction model for vascular surgery candidates. Background. Patients who require surgical treatment of peripheral vascular disease are atincreased risk of perioperative cardiac morbidity and mortality. Existing prediction models tend to underestimate risk in vascular surgery candidates. Methods. The cohort comprised 1,081 consecutive vascular surgery candidates at five medical centers. Of these, 567 patients fromtwo centers (''training'' set) were used to develop the model, and 514 patients from three centers were used to validate it (''validation''set). Risk scores were developed using logistic regression for clinical variables: advanced age (>70 years), angina, history of myocardial infarction, diabetes mellitus, history of congestive heart failure andprior coronary revascularization. A second model was developed from dipyridamole-thallium predictors of myocardial infarction (i.e., fixed and reversible myocardial defects and ST changes). Model performance was assessed by comparing observed event rates with risk estimates and by performing receiver-operating characteristic curve (ROC) analysis. Results. The postoperative cardiac event rate was 8% for both sets. Prognostic accuracy (i.e., ROC area) was 74 +/- 3% (mean +/- SD) for theclinical and 81 +/- 3% for the clinical and dipyridamole-thallium models. Among the validation sets, areas were 74 +/- 9%, 72 +/- 7% and 76+/- 5% for each center. Observed and estimated rates were comparable for both sets. By the clinical model, the observed rates were 3%, 8% and 18% for patients classified as low, moderate and high risk by clinical factors (p < 0.0001). The addition of dipyridamole-thallium data reclassified >80% of the moderate risk patients into low (3%) and high (19%) risk categories (p < 0.0001) but provided no stratification for patients classified as low or high risk according to the clinical model. Conclusions. Simple clinical markers, weighted according to prognostic impact, will reliably stratify risk in vascular surgery candidatesreferred for dipyridamole-thallium testing, thus obviating the need for the more expensive testing. Our prediction model retains its prognostic accuracy when applied to the validation sets and can reliably estimate risk in this group.

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Documento generato il 24/11/20 alle ore 14:25:12