Multifactorial Index of Cardiac Risk in Noncardiac Surgical Procedures

Goldman, Lee; Caldera, Debra L.; Nussbaum, Samuel R.; Southwick, Frederick S.; Krogstad, Donald J.; Murray, Barbara E.; Burke, Donald S.; O’Malley, Terrence A.; Goroll, Allan H.; Caplan, Charles H.; Nolan, James; Carabello, Blasé A.; Slater, Eve E.

doi:10.1097/00132586-197810000-00051

Cited by 358 publications

(587 citation statements)

References 1 publication

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“…19 In particular, in patients undergoing major vascular surgery, perioperative adverse cardiac outcomes are very high (5-15%) and thus reflect the systemic nature of the atherosclerotic process with common risk factors between CAD and peripheral vascular disease. 9 As a consequence, there exists a significant need for a simple, safe, and cost-effective method to 7,20,21 In these studies, history of CAD, congestive heart failure, diabetes mellitus, and chronic renal failure all increased the risk of perioperative cardiac adverse events. In our experience, no parameter significantly affected perioperative cardiac mortality; however, age >80 years, chronic renal failure, congestive heart failure, and valvular heart disease affected cardiac morbidity.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Cardiac Assessment in Patients Undergoing Aortic Surgery: Analysis of Factors Affecting the Cardiac Outcomes

Troisi

Dorigo

Sapio

et al. 2010

Annals of Vascular Surgery

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Background: The purpose of this study was to evaluate the effectiveness of a standardized preoperative cardiac assessment in reducing the rate of perioperative cardiac complications in patients undergoing aortic surgery, paying particular attention to the analysis of the factors affecting perioperative cardiac outcomes. Methods: Between January 2005 and August 2008, a total of 531 elective interventions for abdominal aortic aneurysms were performed at our institution. All patients underwent preoperative evaluation on an outpatient basis, which included a standardized cardiac assessment protocol to evaluate perioperative cardiac risk. A surgical (open or endovascular) intervention was performed in all patients and perioperative (<30 days) results in terms of overall and cardiac mortality and morbidity rates were recorded. Results: Preoperative electrocardiogram, transthoracic echocardiography, and cardiology consultation were performed in all patients. In 348 cases (65.5%), further evaluation of cardiac functional capacity with noninvasive stress testing was recommended. A positive noninvasive stress test was noted in 86 (24.7%) of 348 patients and coronary angiography was performed in 34 (39.5%) of 86 patients. Thirteen of these patients underwent successful coronary revascularization (11 percutaneous transluminal coronary angioplasty, two coronary artery bypass graft) before vascular surgery. Thirty-day overall rate and cardiac mortality rate were 1.1% and 0.6%, respectively, and 30-day overall and cardiac morbidity rates were 11.5% and 6.8%, respectively. Univariate analysis demonstrated that in patients aged >80 years, chronic renal failure, congestive heart failure, valvular heart disease, positive noninvasive stress testing, and open surgical treatment significantly affected 30-day cardiac morbidity; however, only valvular heart disease and positive noninvasive stress testing maintained their significance with multivariate analysis ( p ¼ 0.005; 95% CI, 1.6-14.4; and p ¼ 0.02; 95% CI, 1.2-8

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Section: Discussionmentioning

confidence: 99%

Preoperative Cardiac Assessment in Patients Undergoing Aortic Surgery: Analysis of Factors Affecting the Cardiac Outcomes

Troisi

Dorigo

Sapio

et al. 2010

Annals of Vascular Surgery

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“…As part of a large cohort study used to develop the first widely employed cardiac risk index for noncardiac surgery, Goldman et al found 13% (3/23 patients) cardiac mortality among patients with ''important valvular AS.'' 17 In comparison, cardiac mortality among 978 patients without identified AS was 1.6% (16/978 patients).…”

Section: Noncardiac Surgery and Asmentioning

confidence: 96%

Core competency review: Aortic stenosis and noncardiac surgery

Wright

Hunt

2012

Journal of Hospital Medicine

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Aortic stenosis (AS) poses a risk of adverse cardiac events for patients undergoing surgical procedures. Perioperative mortality for patients with severe AS is as high as 14%. This review examines the accuracy of the history and physical examination in detecting AS and, subsequently, in assessing severity. The utility of echocardiography is addressed, and the relevant pathophysiology of AS is summarized. We also summarize what is known about perioperative risk for patients with AS. Journal of Hospital Medicine 2012;. © 2012 Society of Hospital Medicine

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“…in the Cardiac Risk Index, the factor given the greatest weight is the presence of an $3 gallop, usually associated with CHF. 33 Recent investigations suggest that patients with preoperative ischaemia (silent or anginal) are a greater risk for postoperative complications. In a study of vascular surgical patients, 38% of those who had a postoperative cardiac event had preoperative ischaemia.…”

Section: Assigning Cardiac Risk In the Perioperative Periodmentioning

confidence: 99%

“…Dans I'lndex de risque cardiaque, le facteur qui a la plus grande pond6ration est ia pr6sence d'un gallop en $3, habituellement associ6 ~ de I'insuffisance cardiaque congestive. 33 Des travaux r6cents sugg6,rent que les patients avec isch~mie pr~-op~ratoire (silencieuse ou symptomatique) pr6sentent un risque plus 61ev6 de complications postop6ratoires. Dans une revue de patients soumis /L la chirurgie vasculaire, 38% de ceux qui pr6sentaient un ~pisode cardiaque post-op~ratoire avaient une isch6mie pr6-op~ratoire.…”

Section: Maladie Coronarienneunclassified

Preoperative evaluation of the cardiac patient for noncardiac surgery

Barash

1991

Can J Anaesth

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Multifactorial Index of Cardiac Risk in Noncardiac Surgical Procedures

Cited by 358 publications

References 1 publication

Preoperative Cardiac Assessment in Patients Undergoing Aortic Surgery: Analysis of Factors Affecting the Cardiac Outcomes

Preoperative Cardiac Assessment in Patients Undergoing Aortic Surgery: Analysis of Factors Affecting the Cardiac Outcomes

Core competency review: Aortic stenosis and noncardiac surgery

Preoperative evaluation of the cardiac patient for noncardiac surgery

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