Agreement between three perioperative risk scores

Area of Science:

• Cardiology
• Anesthesiology
• Medical Informatics

Background:

• Preoperative cardiac risk assessment is crucial for non-cardiac surgery.
• The Brazilian Society of Cardiology's II Guideline suggests three risk scores: ACP, EMAPO, and RCRI.
• Evaluating the agreement between these scores is essential for clinical practice.

Purpose of the Study:

• To assess the agreement among three cardiac risk scores: American College of Physicians (ACP) algorithm, Multicenter Study of Perioperative Evaluation (EMAPO), and Lee's Revised Cardiac Risk Index (RCRI).
• To determine the reliability of these scores as recommended by the Brazilian Society of Cardiology's II Guideline for Perioperative Evaluation.

Main Methods:

• A cohort of 401 patients undergoing non-cardiac surgery were evaluated preoperatively.
• Risk stratification was performed using the ACP, EMAPO, and RCRI algorithms.
• Cohen's kappa index was employed to quantify the inter-rater agreement between the scores.

Main Results:

• A weak overall agreement was observed between the three risk scores (kappa = 0.270).
• The strongest pairwise agreement was between EMAPO and ACP (kappa = 0.327).
• Lee's RCRI classified the highest proportion of patients as low-risk (98.3%).

Conclusions:

• There is poor correlation among the cardiac risk scores recommended by the SBC's II Guideline.
• The findings indicate potential variability in patient risk classification when using these different scores.
• Further research may be needed to refine perioperative risk assessment tools.