Preoperative assessment of cardiovascular risk in patients undergoing noncardiac surgery: the Orion study

  • Giampaolo Scorcu | giampaolo.scorcu@gmail.com Simple Departmental Structure (SSD) of Outpatient Cardiology Consultancy and Evaluation, “G. Brotzu” Hospital, Cagliari, Italy.
  • Annarita Pilleri Simple Departmental Structure (SSD) of Outpatient Cardiology Consultancy and Evaluation, “G. Brotzu” Hospital, Cagliari, Italy.
  • Paolo Contu Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy.
  • Pompilio Faggiano Cardiology Unit, Spedali Civili, Brescia, Italy.
  • Roberto Floris Clinical Cardiology, “San Giovanni di Dio” Hospital, Cagliari, Italy.
  • Alessandra Mereu Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy.
  • Luisella Pistis Simple Departmental Structure (SSD) of Outpatient Cardiology Consultancy and Evaluation, “G. Brotzu” Hospital, Cagliari, Italy.
  • Roberto Sessego Departmental Structure of Anesthesia and Analgesic Therapy, “G. Brotzu” Hospital, Cagliari, Italy.
  • Luigi Valentino Departmental Structure of Cardiology, “G. Brotzu” Hospital, Cagliari, Italy.
  • Claudia Sardu Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy.

Abstract

In patients undergoing noncardiac surgery risk indices can estimate patients’ perioperative risk of major cardiovascular complications. The indexes currently in use were derived from observational studies that are now outdated with respect to the current clinical context. We undertook a prospective, observational, cohort study to derive, validate, and compare a new risk index with established risk indices. We evaluated 7335 patients (mean age 63±13 years) who underwent noncardiac surgery. Based on prospective data analysis of 4600 patients (derivation cohort) we developed an Updated Cardiac Risk Score (UCRS), and validated the risk score on 2735 patients (validation cohort). Four variables (i.e. the UCRS) were significantly associated with the risk of a major perioperative cardiovascular events: high-risk surgery, preoperative estimate glomerular filtration rate <30 ml/min/1.73 m2, age ≥75 years, and history of heart failure. Based on the UCRS we created risk classes 1,2,3 and 4 and their corresponding 30-day risk of a major cardiovascular complication was 0.8% [95% confidence interval (CI) 0.5-1.7], 2.5 (95% CI 1.6-5.6), 8.7 (95% CI 5.2-18.9) and 27.2 (95% CI 11.8-50.3), respectively. No significant differences were found between the derivation and validation cohorts. Receiver operating characteristic (ROC) curves demonstrate a high predictive performance of the new index, with greater power to discriminate between the various classes of risk than the indexes currently used. The high predictive performance and simplicity of the UCRS make it suitable for wide-scale use in preoperative cardiac risk assessment of patients undergoing noncardiac surgery.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.
Published
2020-02-06
Info
Issue
Section
Cardiology - Original Articles
Keywords:
Non-cardiac surgery, perioperative management, risk factors
Statistics
  • Abstract views: 623

  • PDF: 319
How to Cite
Scorcu, G., Pilleri, A., Contu, P., Faggiano, P., Floris, R., Mereu, A., Pistis, L., Sessego, R., Valentino, L., & Sardu, C. (2020). Preoperative assessment of cardiovascular risk in patients undergoing noncardiac surgery: the Orion study. Monaldi Archives for Chest Disease, 90(1). https://doi.org/10.4081/monaldi.2020.1169