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A New Tool for Assessing Cardiac Risk in Noncardiac Surgery

One purpose of a preoperative medical evaluation is to determine a patient's risk for cardiac complications. These researchers developed an index for predicting cardiac complications (i.e., myocardial infarction, pulmonary edema, ventricular fibrillation, cardiac arrest, and complete heart block) among patients undergoing major nonemergent noncardiac surgery. The index was derived from 2,893 patients and validated in 1,422 patients, all aged 50 or older.

The model identified six independent predictors of cardiac complications: high-risk surgery, history of ischemic heart disease, history of congestive heart failure, history of cerebrovascular disease, insulin therapy, and serum creatinine above 2.0 mg/dl. In the derivation cohort, the presence of zero, one, two, or more than two predictors was associated with cardiac complication rates of 0.5 percent, 1.3 percent, 3.6 percent, and 9.1 percent, respectively. Outcomes were similar in the validation cohort.

Comment: This model, called the "Revised Cardiac Risk Index" by the authors, performed more accurately in this population than two well-known, previously published indexes (those of Goldman and Detsky). What remains open to debate is how clinicians should use these data. Possibilities for patients with two or more risk factors include preoperative noninvasive testing for coronary disease or strategies to reduce intra- and postoperative oxygen consumption.

— AS Brett

Published in Journal Watch General Medicine September 17, 1999

Citation(s):

Lee TH et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 1999 Sep 7 100 1043-1049.

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