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Age-specific performance of the revised cardiac risk index for predicting cardiovascular risk in elective noncardiac
Charlotte Andersson1, Mads Wissenberg2, Mads Emil Jørgensen2
1From the Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (C.A., M.W., M.E.J., C.M., G.H.G.); Department of Health Research and Policy, Stanford University, CA (M.A.H.); Department of Cardiothoracic Anesthesia, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (P.F.J.); The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.); The Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (L.K.); and Institute of Health, Science and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.). ca@heart.dk.
Insights
The revised cardiac risk index (RCRI) effectively predicts major adverse cardiovascular events in noncardiac surgery patients across all ages. While sensitivity varies, its high negative predictive value ensures reliable risk assessment for preoperative cardiac evaluation.
Area of Science:
- Cardiology
- Anesthesiology
- Geriatric Medicine
Background:
- The revised cardiac risk index (RCRI) is crucial for preoperative cardiac risk stratification in noncardiac surgery.
- Its performance across diverse age groups in unselected populations requires systematic investigation.
Purpose of the Study:
- To assess the relationship between RCRI and major adverse cardiovascular events (MACE).
- To evaluate RCRI performance in an unselected cohort undergoing elective noncardiac surgery, stratified by age groups.
Main Methods:
- A nationwide cohort study in Denmark (2005-2011) included patients aged ≥25 undergoing major elective noncardiac surgery.
- Follow-up for 30-day MACE (ischemic stroke, myocardial infarction, cardiovascular death).
- Multivariable logistic regression and C-statistic analysis were used to assess RCRI performance across age groups.
Main Results:
- MACE rates increased with RCRI classes (0.2% in Class I to 8% in Class IV).
- Key predictors of MACE included cerebrovascular disease (OR 10.02), ischemic heart disease (OR 3.30), and high-risk surgery (OR 2.70).
- RCRI C-statistic was highest in the 56-65 age group (0.772) and lowest in those >85 years (0.683). Sensitivity for RCRI >I was moderate (59-71%), but negative predictive value exceeded 98% across all ages.
Conclusions:
- RCRI performance in an unselected, nationwide cohort was comparable to the original study.
- Identifying patients with ≥1 RCRI risk factor offers moderate sensitivity but high negative predictive value for MACE across all adult age groups.
Background:
The revised cardiac risk index (RCRI) holds a central role in preoperative cardiac risk stratification in noncardiac surgery. Its performance in unselected populations, including different age groups, has, however, not been systematically investigated. We assessed the relationship of RCRI with major adverse cardiovascular events in an unselected cohort of patients undergoing elective, noncardiac surgery overall and in different age groups.
Methods And Results:
We followed up all individuals ≥ 25 years who underwent major elective noncardiac surgery in Denmark (January 1, 2005, to November 30, 2011) for the 30-day risk of major adverse cardiovascular events (ischemic stroke, myocardial infarction, or cardiovascular death). There were 742 of 357,396 (0.2%), 755 of 74.889 (1.0%), 521 of 11,921 (4%), and 257 of 3146 (8%) major adverse cardiovascular events occurring in RCRI classes I, II, III, and IV. Multivariable odds ratio estimates were as follows: ischemic heart disease 3.30 (95% confidence interval, 2.96-3.69), high-risk surgery 2.70 (2.46-2.96), congestive heart failure 2.65 (2.29-3.06), cerebrovascular disease 10.02 (9.08-11.05), insulin therapy 1.62 (1.37-1.93), and kidney disease 1.45 (1.33-1.59). Modeling RCRI classes as a continuous variable, C statistic was highest among age group 56 to 65 years (0.772) and lowest for those aged >85 years (0.683). Sensitivity of RCRI class >I (ie, having ≥ 1 risk factor) for capturing major adverse cardiovascular events was 59%, 71%, 64%, 66%, and 67% in patients aged ≤ 55, 56 to 65, 66 to 75, 76 to 85, and >85 years, respectively; the negative predictive values were >98% across all age groups.
Conclusions:
In a nationwide unselected cohort, the performance of the RCRI was similar to that of the original cohort. Having ≥ 1 risk factor was of moderate sensitivity, but high negative predictive value for all ages.
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