Prospective assessment of different indices of cardiac risk for patients undergoing noncardiac surgeries.
OBJECTIVE
To compare the accuracy of 4 different indices of cardiac risk currently used for predicting perioperative cardiac complications.


METHODS
We studied 119 patients at a university-affiliated hospital whose cardiac assessment had been required for noncardiac surgery. Predictive factors of high risk for perioperative cardiac complications were assessed through clinical history and physical examination, and the patients were followed up after surgery until the 4th postoperative day to assess the occurrence of cardiac events. All patients were classified according to 4 indices of cardiac risk: the Goldman risk-factor index, Detsky modified risk index, Larsen index, and the American Society of Anesthesiologists' physical status classification and their compared accuracies, examining the areas under their respective receiver operating characteristic (ROC) curves.


RESULTS
Cardiac complications occurred in 16% of the patients. The areas under the ROC curves were equal for the Goldman risk-factor index, the Larsen index, and the American Society of Anesthesiologists' physical status classification: 0.48 (SEM +/- 0.03). For the Detsky index, the value found was 0.38 (SEM +/- 0.03). This difference in the values was not statistically significant.


CONCLUSIONS
The cardiac risk indices currently used did not show a better accuracy than that obtained randomly. None of the indices proved to be significantly better than the others. Studies to improve our ability to predict such complications are still required.
Heinisch
Roberto Henrique
RH
Universidade Federal de Santa Catarina, Florianápolis, SC, Brazil. heinisch@hu.ufsc.br
Barbieri
Caroline Ferrari
CF
Nunes Filho
João Rogério
JR
Oliveira
Glauce Lippi de
GL
Heinisch
Liana Miriam Miranda
LM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016021:Epidemiologic Studies; D005260:Female; D006331:Heart Diseases / Q000209:etiology*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D013514:Surgical Procedures, Operative / Q000009:adverse effects*