Preoperative assessment of cardiovascular risk in patients undergoing noncardiac surgery: the Orion study

Abstract

In patients undergoing noncardiac surgery risk indices can estimate patients’ perioperative risk of major cardiovascular complications. The indexes currently in use were derived from observational studies that are now outdated with respect to the current clinical context. We undertook a prospective, observational, cohort study to derive, validate, and compare a new risk index with established risk indices. We evaluated 7335 patients (mean age 63±13 years) who underwent noncardiac surgery. Based on prospective data analysis of 4600 patients (derivation cohort) we developed an Updated Cardiac Risk Score (UCRS), and validated the risk score on 2735 patients (validation cohort). Four variables (i.e. the UCRS) were significantly associated with the risk of a major perioperative cardiovascular events: high-risk surgery, preoperative estimate glomerular filtration rate <30 ml/min/1.73 m2, age ≥75 years, and history of heart failure. Based on the UCRS we created risk classes 1,2,3 and 4 and their corresponding 30-day risk of a major cardiovascular complication was 0.8% [95% confidence interval (CI) 0.5-1.7], 2.5 (95% CI 1.6-5.6), 8.7 (95% CI 5.2-18.9) and 27.2 (95% CI 11.8-50.3), respectively. No significant differences were found between the derivation and validation cohorts. Receiver operating characteristic (ROC) curves demonstrate a high predictive performance of the new index, with greater power to discriminate between the various classes of risk than the indexes currently used. The high predictive performance and simplicity of the UCRS make it suitable for wide-scale use in preoperative cardiac risk assessment of patients undergoing noncardiac surgery.

Update in perioperative cardiac medicine 2021

“…The former included emergency surgery as well as some low-risk procedures, and the outcomes studied included stroke and allcause mortality at 30 days, which were not included in the Revised Cardiac Risk Index. 4 The Updated Cardiac Risk Score Scorcu et al 5 The areas under the curve were higher for the UCRS than the Revised Cardiac Risk Index in both the derivation cohort (0.86 vs 0.79) and the validation cohort (0.77 vs 0.72). This study evaluated a wider range of complications than did the Revised Cardiac Risk Index, but like the Revised Cardiac Risk Index, it was a single-institution study and used creatine kinase-MB, not troponin, for postoperative surveillance.…”