| 배명환, 최원석, 김균희, 박선희, 이장훈, 양동헌, 박헌식, 조용근, 채성철, 전재은 |
Background: There was not known regarding the significance of the fragmented QRS complex (fQRS) in high risk patients undergoing vascular surgery with high risk for postoperative cardiac events. We postulated that newly reclassified fragmented revised cardiac risk index (RCRI) might improve the ability to stratify the cardiac risk of patients undergoing non-cardiac vascular surgery. Methods: A total of 428 consecutive patients (69.6±10.0 years; 367 males) who underwent myocardial perfusion SPECT for non-cardiac vascular surgery were studies. All patients were classified as the RCRI 0, 1, 2, ≥3 group according to the sum of diabetes, renal insufficiency, histories of ischemic heart disease (IHD), congestive heart failure (CHF), and cerebrovascular disease (CVD) and then newly reclassified as fragmented RCRI (fRCRI) 0, 1, 2, ≥3 group including the fQRS. Results: The fQRS and myocardial ischemia and/or scar were present in 159 (37.1%) and 87 (20.3%) patients, respectively. The fQRS (OR 3.102, 95% CI 1.725 to 5.580, P<0.001) was an independent predictor for myocardial ischemia and/or scar after adjusting the RCRI and Q wave on the ECG. The incidence of the RCRI 0, 1, 2 and 3 was 50.5% (n=216), 33.2% (n=142), 13.1% (n=56), and 3.3% (n=14), respectively. When the data for the fRCRI including the fQRS were analyzed, 31 patients (55.4%) belonged to the RCRI 2 were reclassified as the fRCRI 3 (Figure 1). Compared with the RCRI 3 for prediction of myocardial ischemia and/or scar, the fRCRI 3 had an additional increment in sensitivity (18.4%) (Figure 1). Newly reclassified fRCRI significantly improved the predictive ability of the RCRI for myocardial ischemia and/or scar (chi-square 17, net reclassification improvement 0.522, integrated discrimination improvement 0.044, P<0.001, respectively). Conclusion: The fQRS is an independent predictor for myocardial ischemia and/or scar and newly reclassified fRCRI including the fQRS was more powerful for cardiac risk stratification of patients undergoing non-cardiac vascular surgery.
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