 |
 |
|
|
|  PubMed
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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. BRIEF COMMUNICATION
Prospective Evaluation of Cardiac Risk Indices for Patients Undergoing Noncardiac Surgery
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  A. Brunelli, A. Charloux, C. T. Bolliger, G. Rocco, J-P. Sculier, G. Varela, M. Licker, M. K. Ferguson, C. Faivre-Finn, R. M. Huber, et al. ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy) Eur. Respir. J., July 1, 2009; 34(1): 17 - 41. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Gregoratos Current Guideline-Based Preoperative Evaluation Provides the Best Management of Patients Undergoing Noncardiac Surgery Circulation, June 17, 2008; 117(24): 3134 - 3144. [Full Text] [PDF]
|
|
|
|
 |
|
 T. Laitio, J. Jalonen, T. Kuusela, and H. Scheinin The Role of Heart Rate Variability in Risk Stratification for Adverse Postoperative Cardiac Events Anesth. Analg., December 1, 2007; 105(6): 1548 - 1560. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. H. Cuthbertson, A. R. Amiri, B. L. Croal, S. Rajagopalan, O. Alozairi, J. Brittenden, and G. S. Hillis Utility of B-type natriuretic peptide in predicting perioperative cardiac events in patients undergoing major non-cardiac surgery Br. J. Anaesth., August 1, 2007; 99(2): 170 - 176. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 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]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 B. M. Reilly and A. T. Evans Translating Clinical Research into Clinical Practice: Impact of Using Prediction Rules To Make Decisions Ann Intern Med, February 7, 2006; 144(3): 201 - 209. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. M. RuDusky Perioperative Sublingual Isosorbide Dinitrate for the Prevention of Cardiac Complications in Cardiac Patients Undergoing Noncardiac Surgery Angiology, November 1, 2005; 56(6): 755 - 760. [Abstract] [PDF]
|
|
|
|
 |
|
 D. Redelmeier, D. Scales, and A. Kopp {beta} blockers for elective surgery in elderly patients: population based, retrospective cohort study BMJ, October 22, 2005; 331(7522): 932. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 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]
|
|
|
|
|
|
L. Glantz, T. Ezri, Y. Cohen, S. Konichezky, A. Caspi, D. Geva, and A. Leviav Perioperative Myocardial Ischemia in Patients Undergoing Sternectomy Shortly After Coronary Artery Bypass Grafting Anesth. Analg., June 1, 2003; 96(6): 1566 - 1571. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. D. Auerbach and L. Goldman {beta}-Blockers and Reduction of Cardiac Events in Noncardiac Surgery: Scientific Review JAMA, March 20, 2002; 287(11): 1435 - 1444. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. D. Auerbach and L. Goldman {beta}-Blockers and Reduction of Cardiac Events in Noncardiac Surgery: Clinical Applications JAMA, March 20, 2002; 287(11): 1445 - 1447. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. M. Clarke Comparison of Cardiac Risk Indices Ann Intern Med, August 21, 2001; 135(4): 301 - 302. [Full Text] [PDF]
|
|
|
|
|
|
D. A. Redelmeier and A. J. Lustig Prognostic Indices in Clinical Practice JAMA, June 20, 2001; 285(23): 3024 - 3025. [Full Text] [PDF]
|
|
|
|
 |
|
 Are Postoperative Cardiac Events Unpredictable? Journal Watch Gastroenterology, November 6, 2000; 2000(1106): 16 - 16. [Full Text]
|
|
|
|
 |
|
 Cardiac Risk Indices for Noncardiac Surgery Journal Watch Cardiology, October 27, 2000; 2000(1027): 8 - 8. [Full Text]
|
|
|
|
 |
|
 Are Postoperative Cardiac Events Unpredictable? Journal Watch (General), September 22, 2000; 2000(922): 5 - 5. [Full Text]
|
|
|
|
|
|
D. S. Bach and K. A. Eagle Prediction of Perioperative Risk: The Glass May Be Three-Quarters Full Ann Intern Med, September 5, 2000; 133(5): 384 - 386. [Full Text] [PDF]
|
|
