Predictive Value of Stress Testing, Revised Cardiac Risk Index, and Functional Status in Patients Undergoing...

Area of Science:

• Cardiology
• Anesthesiology
• Perioperative Medicine

Background:

• Patients undergoing noncardiac surgery face risks of postoperative cardiovascular complications.
• Predicting these events is crucial for patient management.
• Existing literature on the predictive capabilities of the Revised Cardiac Risk Index (RCRI), functional capacity, and stress testing is limited.

Purpose of the Study:

• To examine the association between RCRI, functional capacity, and stress testing with perioperative cardiac events.
• To assess the additive value of these parameters in predicting postoperative cardiovascular outcomes.

Main Methods:

• A single-center retrospective study involving 509 patients undergoing noncardiac surgery.
• Evaluation of functional capacity using estimated metabolic equivalents (METSe).
• Analysis of the predictive performance of RCRI, METSe, and stress testing for major adverse cardiac events (MACE) and 1-year mortality.

Main Results:

• The study cohort had predominantly good functional status (METSe ≥4 in 83%).
• Adding preoperative stress testing to RCRI and METSe modestly improved the prediction of MACE (C-statistic 0.77) and 1-year mortality (C-statistic 0.84) compared to RCRI and METSe alone (C-statistic 0.70 for MACE; 0.79 for mortality).
• A high prevalence of false-negative stress tests was observed, without impacting the predictive accuracy of MACE when accounted for.

Conclusions:

• In patients with good functional status and intermediate-to-high RCRI scores, preoperative stress testing provides only moderate additional value in predicting postoperative cardiovascular outcomes.
• The combination of functional capacity and RCRI remains a key predictor of perioperative cardiac events.