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Estimation of cardiac risk before noncardiac surgery: the evolution of cardiac risk indices
Steven L Cohn1, Stalin Subramanian
1Medical Director, UHealth Preoperative Assessment Center, University of Miami, Miami, FL; Director, University of Miami Health System Medical Consultation Service, Miami, FL; Professor of Clinical Medicine, Department of Medicine, Division of Hospital Medicine, University of Miami Miller School of Medicine, Miami FL. scohn@med.miami.edu.
Insights
Assessing preoperative risk for cardiac complications in noncardiac surgery is crucial. This review examines various risk indices to help stratify patients and guide interventions, improving surgical outcomes.
Area of Science:
- Cardiology
- Anesthesiology
- Internal Medicine
Background:
- Postoperative cardiac complications are a significant concern in noncardiac surgery.
- Preoperative consultations are essential for risk assessment and medical optimization.
- Numerous studies have focused on identifying preoperative risk factors.
Purpose of the Study:
- To review and analyze existing risk indices for predicting postoperative cardiac complications.
- To highlight the findings, utility, and limitations of various risk stratification tools.
- To aid clinicians in assessing and managing perioperative cardiac risk.
Main Methods:
- Systematic review of studies on preoperative risk factors and cardiac complications.
- Analysis of various proposed risk indices and algorithms.
- Comparison of different risk stratification methodologies.
Main Results:
- Multiple risk indices exist, varying in identified risk factors, patient populations, and endpoints.
- These indices aim to stratify patients and guide interventions to reduce cardiac risk.
- Each index has specific utilities and limitations based on its development and application.
Conclusions:
- Risk stratification for perioperative cardiac events is complex and evolving.
- Understanding the nuances of different risk indices is vital for clinical decision-making.
- Further research is needed to refine risk prediction and optimize patient care.
Abstract:
Postoperative cardiac complications are among the most feared events in patients undergoing noncardiac surgery. Hospitalists, internists, cardiologists, and anesthesiologists are frequently asked to provide preoperative consultations to assess risk and optimize medical treatment for the patient. Over the years, numerous studies have attempted to define preoperative risk factors in an attempt to risk stratify patients and determine when interventions may be applied to reduce risk. These studies have proposed various risk indices and algorithms based on identification of different risk factors, related to variations in patient populations, types of surgery, definitions of comorbidities, and endpoints studied. This article reviews many of these risk indices, highlighting their findings, utilities, and limitations.
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