(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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