Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery
| Autor: | Thomas H. Lee, Kalon K.L. Ho, Carisi Anne Polanczyk, L. E. Ludwig, M. C. Donaldson, Lee Goldman, D. J. Sugarbaker, Eric J. Thomas, E. F. Cook, A. Pedan, Edward R. Marcantonio, Robert Poss, Carol M. Mangione |
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| Rok vydání: | 1999 |
| Předmět: |
Male
medicine.medical_specialty Heart Diseases Revised Cardiac Risk Index Clinical Sciences Cardiorespiratory Medicine and Haematology Cardiovascular surgery Cohort Studies Postoperative Complications Clinical Research Risk Factors Physiology (medical) Internal medicine medicine Humans Insulin Derivation Prospective Studies Risk factor Prospective cohort study Aged screening and diagnosis Receiver operating characteristic Vascular disease business.industry Prevention Incidence Middle Aged medicine.disease Creatine Prognosis Surgery Detection Cerebrovascular Disorders Heart Disease Cardiovascular System & Hematology Heart failure Public Health and Health Services Female Patient Safety Cardiology and Cardiovascular Medicine business 4.2 Evaluation of markers and technologies Cohort study |
| Zdroj: | Circulation, vol 100, iss 10 Lee, TH; Marcantonio, ER; Mangione, CM; Thomas, EJ; Polanczyk, CA; Cook, EF; et al.(1999). Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. CIRCULATION, 100(10), 1043-1049. doi: 10.1161/01.CIR.100.10.1043. UCLA: Retrieved from: http://www.escholarship.org/uc/item/845640mb |
| ISSN: | 1524-4539 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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