Multifactorial Index of Cardiac Risk in Noncardiac Surgical Procedures

TLDR

The study aimed to identify preoperative factors predicting cardiac complications in patients over 40 undergoing major noncardiac surgery. Using multivariate discriminant analysis on 1001 patients, nine independent preoperative predictors of life‑threatening cardiac events were identified. Patients were stratified into four risk classes, with the highest‑risk group accounting for 10 of 19 cardiac deaths, suggesting the index could predict cardiac risk independently of surgical factors.

Abstract

To determine which preoperative factors might affect the development of cardiac complications after major noncardiac operations, we prospectively studied 1001 patients over 40 years of age. By multivariate discriminant analysis, we identified nine independent significant correlates of life-threatening and fatal cardiac complications: preoperative third heart sound or jugular venous distention; myocardial infarction in the preceding six months; more than five premature ventricular contractions per minute documented at any time before operation; rhythm other than sinus or presence of premature atrial contractions on preoperative electrocardiogram; age over 70 years; intraperitoneal, intrathoracic or aortic operation; emergency operation; important valvular aortic stenosis; and poor general medical condition. Patients could be separated into four classes of significantly different risk. Ten of the 19 postoperative cardiac fatalities occurred in the 18 patients at highest risk. If validated by prospective application, the multifactorial index may allow preoperative estimation of cardiac risk independent of direct surgical risk.