Predictive Value of Stress Testing, Revised Cardiac Risk Index, and Functional Status in Patients Undergoing Noncardiac Surgery
| Autor: | Vijaiganesh Nagarajan, Roop Kaw, Harish Ramakrishna, Adrian V. Hernandez, Meghana Halkar, Likhitesh Jaikumar, Duminda N. Wijeysundera, Divyanshu Mohananey |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Heart Diseases Revised Cardiac Risk Index Stress testing 030204 cardiovascular system & hematology Risk Assessment Metabolic equivalent Cohort Studies 03 medical and health sciences 0302 clinical medicine Postoperative Complications 030202 anesthesiology Predictive Value of Tests Internal medicine Preoperative Care Medicine Humans cardiovascular diseases Aged Retrospective Studies medicine.diagnostic_test business.industry Retrospective cohort study Perioperative Middle Aged Anesthesiology and Pain Medicine Cohort Angiography Cardiology Exercise Test Female Cardiology and Cardiovascular Medicine business Mace |
| Zdroj: | Journal of cardiothoracic and vascular anesthesia. 33(4) |
| ISSN: | 1532-8422 |
| Popis: | Objective Patients undergoing noncardiac surgery are at risk for postoperative cardiovascular complications. Literature regarding the ability of the Revised Cardiac Risk Index (RCRI), functional capacity, and stress testing to predict perioperative cardiac events is scarce. The authors examined the association of these parameters with perioperative cardiac events and their additive ability to predict these outcomes. Design This was a single-center retrospective study conducted at the Cleveland Clinic. Setting Hospital. Participants Patients undergoing noncardiac surgery. Intervention Patients underwent stress testing. Measurements and Main Results The primary outcome of interest was major adverse cardiac events (MACE). The study cohort included 509 patients with a predominantly good functional status, as defined by estimated metabolic equivalents (METSe), which was ≥4 in 83% of the patients. The addition of preoperative stress testing, when indicated based on the RCRI and functional class limitation, only modestly improved discrimination of risk for postoperative outcomes (METSe + RCRI + positive stress test—C statistic 0.77 for MACE; 0.84 for 1-year mortality) compared with the combination of functional capacity (METSe) and RCRI (C statistic 0.70 for MACE; 0.79 for 1-year mortality). A surprisingly high prevalence of false negative stress tests (negative stress tests in patients who later had presence of obstructive coronary disease on angiography) was noted, but the C statistic for MACE remained unchanged, even when no false negative results were assumed. Conclusions In a cohort of patients with predominantly good functional status and intermediate-to-high RCRI scores, addition of a preoperative stress test was of only moderate value in predicting postoperative cardiovascular outcomes compared with a combination of functional class and RCRI. |
| Databáze: | OpenAIRE |
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