Age-Specific Performance of the Revised Cardiac Risk Index for Predicting Cardiovascular Risk in Elective Noncardiac Surgery
Age-Specific Performance of the Revised Cardiac Risk Index for Predicting Cardiovascular Risk in Elective Noncardiac Surgery
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DOI：
10.1161/circoutcomes.114.001298
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发表时间：
2015-01-01
影响因子：
6.9
通讯作者：
Torp-Pedersen, Christian
中科院分区：
文献类型：
--
作者：
Andersson, Charlotte;Wissenberg, Mads;Torp-Pedersen, Christian
背景-修订的心脏风险指数（RCRI）在非心脏手术的术前心脏风险分层中起着核心作用。然而，它在包括不同年龄组在内的少数群体中的表现尚未得到系统的调查。我们评估了RCRI与主要不良心血管事件的关系，在一个接受择期非心脏手术的患者队列中，在不同的年龄组中，我们随访了丹麦所有≥ 25岁接受重大择期非心脏手术的患者（2005年1月1日至2011年11月30日）的30天主要不良心血管事件（缺血性卒中、心肌梗死或心血管死亡）风险。发生RCRI I、II、III和IV级的主要心血管不良事件分别为742/357396（0.2%）、755/74889（1.0%）、521/11921（4%）和257/3146（8%）。多变量比值比估计值如下：心脏病3.30（95%置信区间，2.96-3.69），高风险手术2.70（2.46-2.96），充血性心力衰竭2.65（2.29-3.06）、脑血管疾病10.02（9.08-11.05）、胰岛素治疗1.62（1.37-1.93）和肾脏疾病1.45（1.33-1.59）。将RCRI分类建模为连续变量，C统计量在56至65岁年龄组中最高（0.772），而在>85岁年龄组中最低（0.683）。RCRI>I类（即有>= 1个危险因素）捕捉主要不良心血管事件的敏感性分别为59%，71%，64%，66%和67%，在85岁的患者中，所有年龄组的阴性预测值均>98%。有= 1个危险因素是中等敏感性，但高阴性预测值的所有年龄。
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.Methods and 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 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.