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Vasoactive–Inotropic Score as a Predictor of Long-Term Mortality After Cardiac Surgery
Session:
Prémio Manuel Machado Macedo
Speaker:
Tiago R. Velho
Congress:
CPC 2026
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
26. Cardiovascular Surgery
Subtheme:
26.11 Cardiovascular Surgery - Other
Session Type:
Sessão de Prémios
FP Number:
---
Authors:
Tiago Velho; Rafael M. Pereira; Francisco Luís; Manuel Abecasis; Nuno Carvalho Guerra; Ricardo Ferreira; Luís Ferreira Moita; Ângelo Nobre
Abstract
<p><u><strong>Background</strong></u><br /> Long-term mortality after cardiac surgery remains a major clinical concern. Early postoperative hemodynamic support reflects patient severity, and early organ dysfunction is known to correlate with poorer late outcomes. The vasoactive–inotropic score (VIS) quantifies pharmacological cardiovascular support and has been associated with short-term postoperative morbidity. However, its relationship with long-term prognosis is not well established. This study aimed to assess the association between the maximum VIS in the first 24 hours after cardiac surgery and long-term mortality.</p> <p><u><strong>Methods</strong></u><br /> We conducted an observational, retrospective, single-centre study including consecutive patients undergoing major cardiac surgery between 2018 and 2021. The maximum VIS over the first postoperative 24 hours (VISmax24h) was calculated for each patient. Clinical variables, survival status and time of death were collected. Long-term all-cause mortality was analysed using a Cox proportional hazards model with 60-month follow-up. Model performance was evaluated using time-dependent ROC curves at 12, 24 and 60 months. The proportional hazards assumption was tested with Schoenfeld residuals. Statistical analysis was performed in R.</p> <p><u><strong>Results</strong></u><br /> A total of 1,429 patients were included. Five-year cumulative mortality was 27.4%. VISmax24h was significantly associated with long-term mortality (P=0.006), with higher VIS values corresponding to progressively lower adjusted survival. Kaplan–Meier curves stratified by VIS demonstrated a clear risk gradient. Estimated hazard ratios for VISmax24h values of 5, 100 and 500 were 2.99 (95%CI 1.28–6.97), 8.62 (95%CI 1.56–18.4) and 10.12 (95%CI 2.83–23.3), respectively. Mortality risk was also higher in complex procedures (HR 2.97, P=0.002) and urgent/emergent surgery (HR 2.61, P=0.001). Female sex was protective (HR 0.65, P=0.025). The model showed good discrimination (AUC=0.776).</p> <p><u><strong>Conclusion</strong></u><br /> VISmax24h is an independent predictor of long-term mortality after cardiac surgery. A stepwise increase in risk was observed with higher VIS levels. VIS may serve as an early postoperative prognostic marker, and its incorporation into clinical risk models could enhance long-term outcome prediction.</p>
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