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Prospective Evaluation of Cardiac Risk Indices for Patients Undergoing Noncardiac Surgery

Kenneth Gilbert, MD, FRCPC, MPH; Brian J. Larocque, MD, FRCPC; and Lawrence T. Patrick, MD, FRCPC

5 September 2000 | Volume 133 Issue 5 | Pages 356-359

Background: Prediction of perioperative cardiac complications is important in the medical management of patients undergoing noncardiac surgery. Several indices have been developed to aid prediction, but their performance has not been systematically compared.

Objective: To compare four existing methods for predicting perioperative cardiac risk.

Design: Prospective cohort study.

Setting: Two teaching hospitals in London, Ontario, Canada.

Patients: 2035 patients referred for medical consultation before elective or urgent noncardiac surgery.

Measurements: Myocardial infarction, unstable angina, acute pulmonary edema, or death. The indices were compared by examining the areas under their respective receiver-operating characteristic (ROC) curves.

Results: Cardiac complications occurred in 6.4% of patients. The area under the ROC curve was 0.625 (95% CI, 0.575 to 0.676) for the American Society of Anesthesiologists index, 0.642 (CI, 0.588 to 0.695) for the Goldman index, 0.601 (CI, 0.544 to 0.657) for the modified Detsky index, and 0.654 (0.601 to 0.708) for the Canadian Cardiovascular Society index. These values did not significantly differ.

Conclusions: Existing indices for prediction of cardiac complications perform better than chance, but no index is significantly superior. There is room for improvement in our ability to predict such complications.

Author and Article Information

From University of Western Ontario, London, Ontario, Canada.

Acknowledgments: The authors thank Drs. Ann Kirby, Iain Mackie, and Robert Maykut for their assistance with data collection.

Requests for Single Reprints: Kenneth Gilbert, MD, FRCPC, MPH, Department of Medicine, St. Joseph's Health Centre, 268 Grosvenor Street, Room E209, London, Ontario N6A 4V2, Canada; e-mail, kgilbert{at}julian.uwo.ca.

Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.

Current Author Addresses: Dr. Gilbert: Department of Medicine, St. Joseph's Health Centre, 268 Grosvenor Street, Room E209, London, Ontario N6A 4V2, Canada.

Dr. Larocque: Department of Medicine, St. Joseph's Health Centre, 268 Grosvenor Street, London, Ontario N6A 4V2, Canada.

Dr. Patrick: London Health Sciences Centre, Victoria Campus (South Street), London, Ontario N6A 4G5, Canada.

Author Contributions: Conception and design: K. Gilbert, B.J. Larocque, L.T. Patrick.

Analysis and interpretation of the data: K. Gilbert.

Drafting of the article: K. Gilbert.

Critical revision of the article for important intellectual content: B.J. Larocque, L.T. Patrick.

Final approval of the article: K. Gilbert, B.J. Larocque, L.T. Patrick.

Provision of study materials or patients: B.J. Larocque, L.T. Patrick.

Statistical expertise: K. Gilbert.

Administrative, technical, or logistic support: B.J. Larocque, L.T. Patrick.

Collection and assembly of data: K. Gilbert, B.J. Larocque, L.T. Patrick.

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