Predicting myocardial injury and other cardiac complications after elective noncardiac surgery with the Revised Cardiac Risk Index: the VISION study

Background. Prediction of cardiac complications following orthopaedic and trauma surgery is necessary to improve the quality of treating the elderly patients. Objective. To assess the effectiveness of prognostic scores of perioperative cardiac risk in patients with proximal femoral fracture. Material and methods. We retrospectively reviewed 918 hospital patients with proximal hip fracture from January, 1 2018 to December, 31 2019. Perioperative cardiac risks were assessed using the Goldman Risk Index, Revised Cardiac Risk Index (Lee Index) and Gupta Perioperative Cardiac Risk Index. Results. Cardiac complications occurred in 7 (0.76%) of 918 patients, 6 (0.65%) patients developed acute myocardial infarction, 1 (0.11%) suffered from complete atrioventricular block. Receiver operating characteristic (ROC) curve analysis of the relationship between the time from injury to surgery and cardiovascular complications did not give statistically significant results (AUC (area under a curve) = 0.574, 95% CI (confidence interval): 0.352–0.796). When compared the presence of cardiac complications with the Lee Criteria predictions, significant differences were revealed (p = 0.007), and the Goldman Index data were not statistically significant (p = 0.151). The area under the ROC curve of the corresponding relationship between the prognosis of cardiac complications and the Gupta Index was 0.782 with 95% CI: 0.574–0.991 (p = 0.017), the sensitivity and specificity of the model were 83.3% and 70.4%, respectively. Conclusion. The Goldman Index and Lee Index have no significant value for predicting perioperative cardiac complications in patients with proximal femoral fracture. The Gupta Index has an acceptable level of sensitivity and specificity in predicting cardiac complications.

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The Influence of Aging on the Prognostic Value of the Revised Cardiac Risk Index for Postoperative Cardiac Complications in Vascular Surgery Patients

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2007.05.002 ◽

2007 ◽

Vol 34 (6) ◽

pp. 632-638 ◽

Cited By ~ 36

Author(s):

G.M.J.M. Welten ◽

O. Schouten ◽

R.T. van Domburg ◽

H.H.H. Feringa ◽

S.E. Hoeks ◽

...

Keyword(s):

Vascular Surgery ◽

Prognostic Value ◽

Risk Index ◽

Cardiac Risk ◽

Cardiac Complications ◽

Cardiac Risk Index

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External Validation of the Recalibrated Thoracic Revised Cardiac Risk Index for Predicting the Risk of Major Cardiac Complications After Lung Resection

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2011.03.095 ◽

2011 ◽

Vol 92 (2) ◽

pp. 445-448 ◽

Cited By ~ 37

Author(s):

Alessandro Brunelli ◽

Stephen D. Cassivi ◽

Juan Fibla ◽

Lisa A. Halgren ◽

Dennis A. Wigle ◽

...

Keyword(s):

Risk Index ◽

Lung Resection ◽

External Validation ◽

Cardiac Risk ◽

Cardiac Complications ◽

Cardiac Risk Index

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Cardiac risk assessment with the Revised Cardiac Risk Index index before elective non-cardiac surgery: A retrospective audit from an Australian tertiary hospital

Anaesthesia and Intensive Care ◽

10.1177/0310057x211024661 ◽

2021 ◽

pp. 0310057X2110246

Author(s):

Yao Yao ◽

Ashok Dharmalingam ◽

Cyril Tang ◽

Harrison Bell ◽

Andrew DJ McKeown ◽

...

Keyword(s):

Cardiac Surgery ◽

Risk Index ◽

Cardiac Risk ◽

Tertiary Hospital ◽

Major Adverse Cardiac Events ◽

Cardiac Complications ◽

Cardiac Events ◽

Prognostic Accuracy ◽

Cardiac Risk Index ◽

Adverse Cardiac Events

Clinicians assessing cardiac risk as part of a comprehensive consultation before surgery can use an expanding set of tools, including predictive risk calculators, cardiac stress tests and measuring serum natriuretic peptides. The optimal assessment strategy is unclear, with conflicting international guidelines. We investigated the prognostic accuracy of the Revised Cardiac Risk Index for risk stratification and cardiac outcomes in patients undergoing elective non-cardiac surgery in a contemporary Australian cohort. We audited the records for 1465 consecutive patients 45 years and older presenting to the perioperative clinic for elective non-cardiac surgery in our tertiary hospital. We calculated individual Revised Cardiac Risk Index scores and documented any use of preoperative cardiac tests. The primary outcome was any major adverse cardiac events within 30 days of surgery, including myocardial infarction, pulmonary oedema, complete heart block or cardiac death. Myocardial perfusion imaging was the most common preoperative stress test (4.2%, 61/1465). There was no routine investigation of natriuretic peptide levels for cardiac risk assessment before surgery. Major adverse cardiac events occurred in 1.3% (18/1366) of patients who had surgery. The Revised Cardiac Risk Index score had modest prognostic accuracy for major cardiac complications, area under receiver operator curve 0.73, 95% confidence interval 0.60 to 0.86. Stratifying major adverse cardiac events by the Revised Cardiac Risk Index scores 0, 1, 2 and 3 or greater corresponded to event rates of 0.6% (4/683), 0.8% (4/488), 4.1% (6/145) and 8.0% (4/50), respectively. The Revised Cardiac Risk Index had only modest predictive value in our single-centre experience. Patients with a revised cardiac risk index score of 2 or more had an elevated risk of early cardiac complications after elective non-cardiac surgery.

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Kinetics of troponin I in patients with myocardial injury after noncardiac surgery

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2016-0301 ◽

2017 ◽

Vol 55 (4) ◽

Cited By ~ 1

Author(s):

Judith A.R. van Waes ◽

Linda M. Peelen ◽

Hans Kemperman ◽

Remco B. Grobben ◽

Hendrik M. Nathoe ◽

...

Keyword(s):

Predictive Value ◽

Myocardial Injury ◽

Troponin I ◽

Risk Index ◽

Cardiac Risk ◽

Noncardiac Surgery ◽

Added Value ◽

Troponin Elevation ◽

Kinetics Of ◽

Worse Prognosis

Abstract Background: Myocardial injury after noncardiac surgery, as measured by troponin elevation, is strongly associated with mortality. However, it is unknown in which patients prognosis can be improved. The presence of kinetic changes of troponin may be associated with a worse prognosis and warrant more aggressive management. Therefore, we aimed to study the kinetics of troponin in patients with postoperative myocardial injury, and to determine the added predictive value of kinetic changes of troponin on mortality. Methods: This cohort study included patients with myocardial injury after noncardiac surgery. Troponin I (TnI) was measured on the first three postoperative days. The primary outcome was all-cause 1-year mortality. We studied both absolute and relative TnI changes, and determined the delta TnI that was associated with mortality to distinguish a rise-and-fall TnI pattern from a stable TnI pattern. Next, we determined the added predictive value of a rise-and-fall TnI pattern for mortality. Results: In total, 634 patients were included. The risk ratio (RR) for mortality increased significantly with an absolute delta TnI of ≥200 ng/L (RR 1.5, 99.4% CI 1.0–2.2, p=0.003). Using this delta TnI to define a rise-and-fall pattern, 459 patients (72%) had a stable TnI pattern and 175 patients (28%) had a rise-and-fall pattern. When added to a model including the highest TnI value and variables from the revised cardiac risk index (RCRI), the TnI pattern did not increase the predictive value for mortality. Conclusions: A postoperative TnI rise-and-fall pattern was associated with 1-year mortality, but had no added value in addition to the highest TnI level to predict 1-year mortality. Therefore, postoperative TnI kinetics are not useful for further mortality risk stratification in patients with myocardial injury after noncardiac surgery.

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