(Circulation. 1999;100:1043-1049.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Derivation and Prospective Validation of a Simple Index for Prediction of Cardiac Risk of Major Noncardiac Surgery
From the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, and the Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, Calif (L.G.).
Background—Cardiac complications are important causes of morbidity after noncardiac surgery. The purpose of this prospective cohort study was to develop and validate an index for risk of cardiac complications.
Methods and Results—We studied 4315 patients aged 
50 years
undergoing elective major noncardiac procedures in a tertiary-care
teaching hospital. The main outcome measures were major cardiac
complications. Major cardiac complications occurred in 56 (2%) of 2893
patients assigned to the derivation cohort. Six independent predictors
of complications were identified and included in a Revised Cardiac Risk
Index: high-risk type of surgery, history of ischemic heart
disease, history of congestive heart failure, history of
cerebrovascular disease, preoperative treatment with insulin, and
preoperative serum creatinine >2.0 mg/dL. Rates of major
cardiac complication with 0, 1, 2, or 3 of these factors were 0.5%,
1.3%, 4%, and 9%, respectively, in the derivation cohort and 0.4%,
0.9%, 7%, and 11%, respectively, among 1422 patients in the
validation cohort. Receiver operating characteristic curve
analysis in the validation cohort indicated that the
diagnostic performance of the Revised Cardiac Risk
Index was superior to other published risk-prediction indexes.
Conclusions—In stable patients undergoing nonurgent major noncardiac surgery, this index can identify patients at higher risk for complications. This index may be useful for identification of candidates for further risk stratification with noninvasive technologies or other management strategies, as well as low-risk patients in whom additional evaluation is unlikely to be helpful.
Key Words: risk factors • surgery • prognosis
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 P. G Noordzij, E. Boersma, F. Schreiner, M. D Kertai, H. H H Feringa, M. Dunkelgrun, J. J Bax, J. Klein, and D. Poldermans Increased preoperative glucose levels are associated with perioperative mortality in patients undergoing noncardiac, nonvascular surgery Eur. J. Endocrinol., January 1, 2007; 156(1): 137 - 142. [Abstract] [Full Text] [PDF]
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H. B. Ward, R. F. Kelly, L. Thottapurathu, T. E. Moritz, G. C. Larsen, G. Pierpont, S. Santilli, S. Goldman, W. C. Krupski, F. Littooy, et al. Coronary artery bypass grafting is superior to percutaneous coronary intervention in prevention of perioperative myocardial infarctions during subsequent vascular surgery. Ann. Thorac. Surg., September 1, 2006; 82(3): 795 - 800. [Abstract] [Full Text] [PDF]
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L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al. ACC/AHA 2006 Guideline Update on Perioperative Cardiovascular Evaluation for Noncardiac Surgery: Focused Update on Perioperative Beta-Blocker Therapy: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society for Vascular Medicine and Biology J. Am. Coll. Cardiol., June 6, 2006; 47(11): 2343 - 2355. [Full Text] [PDF]
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 M. J. Press, M. R. Chassin, J. Wang, S. Tuhrim, and E. A. Halm Predicting Medical and Surgical Complications of Carotid Endarterectomy: Comparing the Risk Indexes. Arch Intern Med, April 24, 2006; 166(8): 914 - 920. [Abstract] [Full Text] [PDF]
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G. W. Smetana, V. A. Lawrence, and J. E. Cornell Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med, April 18, 2006; 144(8): 581 - 595. [Abstract] [Full Text] [PDF]
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R. Hanss, B. Bein, P. Turowski, E. Cavus, M. Bauer, M. Andretzke, M. Steinfath, J. Scholz, and P. H. Tonner The influence of xenon on regulation of the autonomic nervous system in patients at high risk of perioperative cardiac complications Br. J. Anaesth., April 1, 2006; 96(4): 427 - 436. [Abstract] [Full Text] [PDF]
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A. Auerbach and L. Goldman Assessing and Reducing the Cardiac Risk of Noncardiac Surgery Circulation, March 14, 2006; 113(10): 1361 - 1376. [Full Text] [PDF]
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M. J. London Beta-Blockade in the Perioperative Period: Where Do We Stand After All the Trials? Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2006; 10(1): 17 - 23. [Abstract] [PDF]
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F. Bursi, L. Babuin, A. Barbieri, L. Politi, M. Zennaro, T. Grimaldi, A. Rumolo, M. Gargiulo, A. Stella, M. G. Modena, et al. Vascular surgery patients: perioperative and long-term risk according to the ACC/AHA guidelines, the additive role of post-operative troponin elevation Eur. Heart J., November 2, 2005; 26(22): 2448 - 2456. [Abstract] [Full Text] [PDF]
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M. Christ, Y. Sharkova, G. Geldner, and B. Maisch Preoperative and Perioperative Care for Patients With Suspected or Established Aortic Stenosis Facing Noncardiac Surgery Chest, October 1, 2005; 128(4): 2944 - 2953. [Abstract] [Full Text] [PDF]
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 P.J. Devereaux, L. Goldman, S. Yusuf, K. Gilbert, K. Leslie, and G. H. Guyatt Surveillance and prevention of major perioperative ischemic cardiac events in patients undergoing noncardiac surgery: a review Can. Med. Assoc. J., September 27, 2005; 173(7): 779 - 788. [Abstract] [Full Text] [PDF]
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P.J. Devereaux, L. Goldman, D. J. Cook, K. Gilbert, K. Leslie, and G. H. Guyatt Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk Can. Med. Assoc. J., September 13, 2005; 173(6): 627 - 634. [Abstract] [Full Text] [PDF]
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 P. K. Lindenauer, P. Pekow, K. Wang, D. K. Mamidi, B. Gutierrez, and E. M. Benjamin Perioperative Beta-Blocker Therapy and Mortality after Major Noncardiac Surgery N. Engl. J. Med., July 28, 2005; 353(4): 349 - 361. [Abstract] [Full Text] [PDF]
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D. Poldermans and E. Boersma Beta-Blocker Therapy in Noncardiac Surgery N. Engl. J. Med., July 28, 2005; 353(4): 412 - 414. [Full Text] [PDF]
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D. J. McCrath, E. Cerboni, R. J. Frumento, A. L. Hirsh, and E. Bennett-Guerrero Thromboelastography Maximum Amplitude Predicts Postoperative Thrombotic Complications Including Myocardial Infarction Anesth. Analg., June 1, 2005; 100(6): 1576 - 1583. [Abstract] [Full Text] [PDF]
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M. Seki, S. Kashimoto, O. Nagata, H. Yoshioka, T. Ishiguro, K. Nishimura, O. Honda, A. Sakamoto, A. Omi, Y. Ogihara, et al. Are the Incidences of Cardiac Events During Noncardiac Surgery in Japan the Same as in the United States and Europe? Anesth. Analg., May 1, 2005; 100(5): 1236 - 1240. [Abstract] [Full Text] [PDF]
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B. Subramaniam, F. Pomposelli, D. Talmor, and K. W. Park Perioperative and Long-Term Morbidity and Mortality After Above-Knee and Below-Knee Amputations in Diabetics and Nondiabetics Anesth. Analg., May 1, 2005; 100(5): 1241 - 1247. [Abstract] [Full Text] [PDF]
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M. O. Baerlocher and A. S. Detsky Does coronary revascularization before major vascular surgery decrease mortality? Can. Med. Assoc. J., April 26, 2005; 172(9): 1180 - 1181. [Full Text] [PDF]
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M. D. Kertai, E. Boersma, J. Klein, H. van Urk, and D. Poldermans Optimizing the Prediction of Perioperative Mortality in Vascular Surgery by Using a Customized Probability Model Arch Intern Med, April 25, 2005; 165(8): 898 - 904. [Abstract] [Full Text] [PDF]
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