Derivation and Prospective Validation of a Simple Index for Prediction of Cardiac Risk of Major Noncardiac Surgery

Lee, T. H.; Marcantonio, Edward R.; Mangione, Carol M.; Thomas, Eric J.; Polanczyk, Carísi Anne; Cook, E. Francis; Sugarbaker, David J.; Donaldson, Magruder C.; Poss, Robert; Ho, Karen; Ludwig, Lynn E.; Pedan, Alex; Goldman, Lee

doi:10.1161/01.cir.100.10.1043

Cited by 3,143 publications

(2,197 citation statements)

References 14 publications

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“…11 The current perioperative guidelines recommend the use of beta-blockers in high-risk cardiac patients undergoing vascular surgery. 12 These recommendations stem from the demonstration that perioperative treatment with betablockers decreased the incidence of cardiac complications and death in very high-risk vascular surgery patients.…”

mentioning

confidence: 99%

Delirium following vascular surgery: increased incidence with preoperative β-blocker administration

Katznelson

Djaiani

Mitsakakis

et al. 2009

Can J Anesth/J Can Anesth

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Purpose To determine if there is an association between perioperative administration of beta-blockers and postoperative delirium in patients undergoing vascular surgery. Methods After Institutional Review Board approval, data were retrospectively collected on patients who underwent vascular surgery in an academic hospital during the period January 2006 to January 2007. Patients with preoperative altered level of consciousness, carotid endarterectomy, or discharge within 24 h of surgery were excluded from the study. Identification of delirium was based on evaluation of the level of consciousness with the NEECHAM Confusion Scale and/or a chart-based instrument for delirium. Multivariable logistic regression analysis was used to identify independent perioperative predictors of postoperative delirium. Beta-blockers were tested for a potential effect. Conclusions Preoperative administration of beta-blockers is associated with an increased risk of postoperative delirium after vascular surgery. Conversely, preoperative statin administration is associated with a lower risk of postoperative delirium. A randomized prospective controlled trial is required to validate these findings. RésuméObjectif De´terminer s'il existe un lien entre l'administration pe´riope´ratoire de beˆta-bloquants et le delirium postope´ratoire chez les patients subissant une chirurgie vasculaire.

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mentioning

confidence: 99%

Delirium following vascular surgery: increased incidence with preoperative β-blocker administration

Katznelson

Djaiani

Mitsakakis

et al. 2009

Can J Anesth/J Can Anesth

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“…The "simple index" for prediction of cardiac risk during major noncardiac surgery identifies six independent risks correlated with higher complications. 5 The six independent predictors of complications identified and included in the Revised Cardiac Risk Index are as follows: …”

Section: Preoperative Cardiac Testingmentioning

confidence: 99%

“…5 Colorectal abdominal procedures are generally considered intermediate risk (reported cardiac risk 1-5%). 6 The Task Force 4 lists active cardiac conditions for which the patient should undergo cardiology evaluation and treatment before noncardiac surgery: unstable coronary syndromes, decompensated heart failure, significant arrhythmias (highgrade AV block, Mobitz 2 AV block, third-degree AV heart block, supraventricular arrhythmias with uncontrolled ventricular rate, symptomatic bradycardia, newly recognized ventricular tachycardia), and severe valvular disease (severe aortic stenosis, symptomatic mitral stenosis).…”

Section: Introductionmentioning

confidence: 99%

Perioperative Beta Blockade

Irani

2013

Clinics in Colon and Rectal Surgery

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The use of preoperative beta (?) blockade has been through several changes, and it is clear that large, randomized controlled trials on the subject are in need. Currently, a judicious approach to perioperative ? blockade is supported. Continuation of ? blockers is recommended for the patient taking them prior to surgery. Patients undergoing large colorectal procedures, with coronary artery disease or high cardiac risk, should have ? blockers titrated to heart rate and blood pressure. Dosages should be titrated to heart rate and blood pressure rather than using fixed, long-acting dosages. When ? blockers are indicated, they should be initiated weeks before surgery.

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“…1 It is also a well-known fact that the peri-operative complications are more frequent following vascular surgery. 2 Number of risk assessment algorithms have been developed and tested, however the revised cardiac risk index (RCRI) 3 described by Lee et al in 1999, remains the most used risk assessment model. These indices are predominantly based on history and simple clinical tools.…”

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confidence: 99%

Revised cardiac risk index—a simple universal tool for peri-operative risk prediction

Deshpande¹

2012

Indian Heart Journal

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Patients subjected to non-cardiac surgery are at a significant risk to develop cardiac complications. With aging populations and improved surgical and anaesthesia techniques, even elderly populations are frequently considered for non-cardiac surgery today. It is estimated that about 40 million non-cardiac surgeries are performed in Europe annually and the perioperative myocardial infarction (MI) occurs at a rate of 1% causing 400,000 myocardial infarcts. Further, the cardiovascular mortality rate of 0.3% gives mortality of 133,000 annually related to non-cardiac surgery. 1 It is also a well-known fact that the peri-operative complications are more frequent following vascular surgery. 2 Number of risk assessment algorithms have been developed and tested, however the revised cardiac risk index (RCRI) 3 described by Lee et al. in 1999, remains the most used risk assessment model. These indices are predominantly based on history and simple clinical tools. Patients with active cardiac conditions like, unstable angina or severe angina, recent MI (within 30 days), significant arrhythmias (advanced heart blocks, atrial fibrillation with uncontrolled ventricular rate, symptomatic ventricular arrhythmias, and symptomatic bradycardia), and severe valvular disease undergoing planned non-cardiac surgery, need to be evaluated extensively, and at times, this may lead to postponement or cancellation of the planned surgery. 4 Patients with risk factors as indicated by the risk scores but without active cardiac conditions need to be evaluated further to prevent postoperative cardiovascular events. A pooled analysis of several studies found a 30-day incidence of cardiac events (postoperative MI and death) of 2.5% in unselected patients >40 years of age. 2 Incidence of postoperative cardiac events varies widely depending upon the tools used to detect myocardial damage as the events may occur silently. Use of sensitive markers like troponins, can detect largely asymptomatic cardiac events. 1 Such patients have higher 6-months event rates as compared to those who do not show elevation of troponins following non-cardiac surgery. Risk assessment prior to planned noncardiac surgery can help in predicting the postoperative events. It also helps the physician and anaesthesiologist to take necessary precautions to minimise the postoperative events.In this issue of the journal Jayakeerthi et al. 5 have reported their experience of pre-operative risk evaluation on 920 patients referred for cardiac assessment. They used RCRI proposed by Lee et al. in 1999 3 for prediction of cardiac events following surgery in 853 patients. The RCRI was described for planned non-cardiac surgery patients, whereas, the cohort described in the current report includes emergent surgical procedures in addition to elective surgeries, which the authors believe reflects the real world. The number of emergency surgeries was relatively small (40/853). Electrocardiogram (ECG) monitoring was done for all patients (pre-operative, immediate postoperative and 1st postoperat...

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Derivation and Prospective Validation of a Simple Index for Prediction of Cardiac Risk of Major Noncardiac Surgery

Cited by 3,143 publications

References 14 publications

Delirium following vascular surgery: increased incidence with preoperative β-blocker administration

Delirium following vascular surgery: increased incidence with preoperative β-blocker administration

Perioperative Beta Blockade

Revised cardiac risk index—a simple universal tool for peri-operative risk prediction

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