Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery
Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery
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DOI：
10.1161/01.cir.100.10.1043
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发表时间：
1999-09-07
期刊：
影响因子：
37.8
通讯作者：
Goldman, L
中科院分区：
文献类型：
--
作者：
Lee, TH;Marcantonio, ER;Goldman, L
心脏并发症是非心脏手术后发病的重要原因。这项前瞻性队列研究的目的是开发和验证心脏并发症的风险指数。方法和结果我们研究了4315例年龄大于或等于50岁的患者进行选择性的主要非心脏手术在三级护理教学医院，主要结果的措施是主要的心脏并发症。在分配至衍生队列的2893例患者中，56例（2%）发生了严重心脏并发症。确定了6个并发症的独立预测因素，并将其纳入修订的心脏风险指数：高风险类型的手术、缺血性心脏病史、充血性心力衰竭史、脑血管病史、术前胰岛素治疗和术前血清肌酐>2.0 mg/dL。在推导队列中，这些因素中有0、1、2或大于或等于3个的严重心脏并发症的发生率分别为0.5%、1.3%、4%和9%，在验证队列的1422例患者中分别为0.4%、0.9%、7%和11%。在验证队列中的受试者工作特征曲线分析表明，修订的心脏风险指数的诊断性能上级其他已发表的风险预测index. Conclusions，在稳定的患者接受非紧急重大非心脏手术，该指数可以识别患者的并发症的风险较高。这个指数可能是有用的，以确定候选人的进一步风险分层与非侵入性技术或其他管理策略，以及低风险的患者中，额外的评估是不太可能有帮助的。
Background-Cardiac complications are important causes of morbidity after noncardiac surgery. The purpose of this prospective cohort study was to develop and validate an index for risk of cardiac complications.Methods and Results-We studied 4315 patients aged greater than or equal to 50 years undergoing elective major noncardiac procedures in a tertiary-care teaching hospital, The main outcome measures were major cardiac complications. Major cardiac complications occurred in 56 (2%) of 2893 patients assigned to the derivation cohort. Six independent predictors of complications were identified and included in a Revised Cardiac Risk Index: high-risk type of surgery, history of ischemic heart disease, history of congestive heart failure, history of cerebrovascular disease, preoperative treatment with insulin, and preoperative serum creatinine >2.0 mg/dL. Rates of major cardiac complication with 0, 1, 2, or greater than or equal to 3 of these factors were 0.5%, 1.3%, 4%, and 9%, respectively, in the derivation cohort and 0.4%, 0.9%, 7%, and 11%, respectively, among 1422 patients in the validation cohort. Receiver operating characteristic curve analysis in the validation cohort indicated that the diagnostic performance of the Revised Cardiac Risk Index was superior to other published risk-prediction indexes.Conclusions-In stable patients undergoing nonurgent major noncardiac surgery, this index can identify patients at higher risk for complications. This index may be useful for identification of candidates for further risk stratification with noninvasive technologies or other management strategies, as well as low-risk patients in whom additional evaluation is unlikely to be helpful.