Examining Risk: A Systematic Review of Perioperative Cardiac Risk Prediction Indices

Wright, Douglas E.; Knuesel, Steven J.; Nagarur, Amulya; Philpotts, Lisa; Greenwald, Jeffrey L.

doi:10.1016/j.mayocp.2019.03.008

Cited by 12 publications

(9 citation statements)

References 46 publications

(107 reference statements)

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“…A systematic review of all cardiac risk prediction indices showed a history of congestive heart failure, type of surgery, DM, emergency surgery, elevated creatinine and history of stroke as important risk factors. [ 28 ] Amongst these, only type of surgery and emergency surgery are included in our scoring tool. A recent systematic review of various available cardiac risk indices concluded that no single risk index gives correct prediction and we need to use two types of scoring tools to estimate cardiac risk in non-cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

“…A recent systematic review of various available cardiac risk indices concluded that no single risk index gives correct prediction and we need to use two types of scoring tools to estimate cardiac risk in non-cardiac surgery. [ 28 ] Perioperative risk prediction models are significant in today’s scenario as there is an emphasis on perioperative quality improvement strategies for better perioperative outcomes. [ 29 ]…”

Section: Discussionmentioning

confidence: 99%

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Predictors of peri-operative cardiac events and development of a scoring tool for patients with chronic kidney disease undergoing non-cardiac surgeries: A prospective observational multicentre study

Deo¹,

Kashyapi

Joshi³

et al. 2022

Indian J Anaesth

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Background and Aims: Cardiovascular diseases are the leading causes of morbidity and mortality in chronic kidney disease (CKD) patients. Our aim was to derive predictors of cardiac morbidity, mortality, cardiac complications and to develop/validate a scoring tool in patients with CKD undergoing non-cardiac surgery. Methods: A prospective observational multicentre study was done on 770 patients with CKD. The primary outcome (“Event”) was one or more than one of sudden cardiac death, pulmonary oedema, acute coronary syndrome, arrhythmia and 30-day mortality. Secondary outcome was hypertension and hypotension. Predictors of cardiac risk were identified. A scoring tool was developed on the 2018 dataset and was validated on the 2019 dataset. Results: The overall incidence of cardiac events was 290 (37.66%) whereas the incidence of major adverse cardiac and cerebrovascular events was 15.04%. Mortality due to cardiac cause was 13 (1.68%). On multivariate regression analysis, seven perioperative variables had significant association with increased risk of events: age > 65 years ( P = 0.004), metabolic equivalents (METS) ≤4 ( P ≤0.032), emergency surgery ( P =0.032), mean arterial pressure >119 ( P = 0.001), echocardiographic scoring ( P = 0.054), type of anaesthesia ( P ≤ 0.0001) and type of surgery ( P = 0.056). Using these variables, a risk stratification tool was developed. C statistics showed favourable predictive accuracy (0.714) and the model showed good calibration. Conclusion: This risk scoring tool based on preoperative variables will help to predict the risk of events in high-risk CKD patients undergoing non-cardiac surgery. This will help in better counselling and optimisation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predictors of peri-operative cardiac events and development of a scoring tool for patients with chronic kidney disease undergoing non-cardiac surgeries: A prospective observational multicentre study

Deo¹,

Kashyapi

Joshi³

et al. 2022

Indian J Anaesth

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“…With modern electronic medical records, decision‐support alerts that identify patients at high risk for postoperative morbidity can enforce a hospital policy for mandatory ICU admission 10 . A systematic review found that the factors most consistently predictive of adverse cardiac outcomes were heart failure, type of surgery (eg, abdominal, orthopedic, vascular), elevated preoperative serum creatinine, diabetes, history of stroke or transient ischemic attack, and emergent surgery 11 …”

Section: Discussionmentioning

confidence: 99%

Too Many Cooks in the Kitchen

2022

AORN Journal

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“…At the molecular level, structural proteins like cTn are released systemically in the presence of a "leaky" plasma membrane and the dissociation of cellular structures like contractile filaments. Experimentally, necrosis of at least 40 mg (~0.015%) of the myocardium is required to systemically detect cTn > 99th percentile of the upper reference limit [15] . cTn is catabolized by the liver, pancreas, and kidneys or as well as by receptor-mediated endocytosis to the endoplasmic reticulum.…”

Section: Pathophysiologymentioning

confidence: 99%