title: Age-specific performance of the revised cardiac risk index for predicting cardiovascular risk in elective noncardiac surgery.
abstract: 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.
  
  
  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.
authors.affiliation: From 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.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Andersson
authors.affiliation: From 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.).
authors.forename: Mads
authors.initials: M
authors.lastname: Wissenberg
authors.affiliation: From 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.).
authors.forename: Mads Emil
authors.initials: ME
authors.lastname: Jørgensen
authors.affiliation: From 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.).
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hlatky
authors.affiliation: From 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.).
authors.forename: Charlotte
authors.initials: C
authors.lastname: Mérie
authors.affiliation: From 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.).
authors.forename: Per Føge
authors.initials: PF
authors.lastname: Jensen
authors.affiliation: From 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.).
authors.forename: Gunnar H
authors.initials: GH
authors.lastname: Gislason
authors.affiliation: From 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.).
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.affiliation: From 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.).
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000209:etiology; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D015897:Comorbidity; D003661:Decision Support Techniques; D003718:Denmark; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D016017:Odds Ratio; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
keywords: cardiovascular diseases; decision support techniques; preoperative care; surgery