Meredith K. Ford, MD, MSc; W. Scott Beattie, MD, PhD; Duminda N. Wijeysundera, MD
These results were presented in part at the 2008 Annual Meeting of the American Society of Anesthesiologists, 18–22 October 2008, Orlando, Florida.
Acknowledgment: The authors thank Dr. Brian Cuthbertson and Dr. David Leibowitz for providing additional unpublished information from their studies.
Grant Support: In part by a Fellowship in Anesthesia from Abbott Laboratories and the Canadian Anesthesiologists' Society (Dr. Ford) and by a Clinician Scientist award from the Canadian Institutes of Health Research and a Merit Award from the Department of Anesthesia at the University of Toronto (Dr. Wijeysundera). Dr. Beattie is the R. Fraser Elliot Chair of Cardiac Anesthesia at the University Health Network.
Potential Conflicts of Interest: None disclosed.
Requests for Single Reprints: Duminda N. Wijeysundera, MD, Department of Anesthesia, Toronto General Hospital and University of Toronto, EN 3-450, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Ford: Department of Anesthesia, Trillium Health Centre, 100 Queensway West, Mississauga, Ontario L5B 1B8, Canada.
Drs. Beattie and Wijeysundera: Department of Anesthesia, Toronto General Hospital and University of Toronto, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
Author Contributions: Conception and design: M.K. Ford, W.S. Beattie, D.N. Wijeysundera.
Analysis and interpretation of the data: M.K. Ford, W.S. Beattie, D.N. Wijeysundera.
Drafting of the article: D.N. Wijeysundera.
Critical revision of the article for important intellectual content: M.K. Ford, W.S. Beattie, D.N. Wijeysundera.
Final approval of the article: W.S. Beattie, D.N. Wijeysundera.
Statistical expertise: W.S. Beattie, D.N. Wijeysundera.
Obtaining of funding: W.S. Beattie.
Administrative, technical, or logistic support: W.S. Beattie, D.N. Wijeysundera.
Collection and assembly of data: M.K. Ford, W.S. Beattie, D.N. Wijeysundera.
Ford M., Beattie W., Wijeysundera D.; Systematic Review: Prediction of Perioperative Cardiac Complications and Mortality by the Revised Cardiac Risk Index. Ann Intern Med. 2010;152:26-35. doi: 10.7326/0003-4819-152-1-201001050-00007
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Published: Ann Intern Med. 2010;152(1):26-35.
The Revised Cardiac Risk Index (RCRI) is widely used to predict perioperative cardiac complications.
To evaluate the ability of the RCRI to predict cardiac complications and death after noncardiac surgery.
MEDLINE, EMBASE, and ISI Web of Science (1966 to 31 December 2008).
Cohort studies that reported the association of the RCRI with major cardiac complications (cardiac death, myocardial infarction, and nonfatal cardiac arrest) or death in the hospital or within 30 days of surgery.
Two reviewers independently extracted study characteristics, documented outcome data, and evaluated study quality.
Of 24 studies (792Â 740 patients), 18 reported cardiac complications; 6 of the 18 studies were prospective and had uniform outcome surveillance and blinded outcome adjudication. The RCRI discriminated moderately well between patients at low versus high risk for cardiac events after mixed noncardiac surgery (area under the receiver-operating characteristic curve [AUC], 0.75 [95% CI, 0.72 to 0.79]); sensitivity, 0.65 [CI, 0.46 to 0.81]; specificity, 0.76 [CI, 0.58 to 0.88]; positive likelihood ratio, 2.78 [CI, 1.74 to 4.45]; negative likelihood ratio, 0.45 [CI, 0.31 to 0.67]). Prediction of cardiac events after vascular noncardiac surgery was less accurate (AUC, 0.64 [CI, 0.61 to 0.66]; sensitivity, 0.70 [CI, 0.53 to 0.82]; specificity, 0.55 [CI, 0.45 to 0.66]; positive likelihood ratio, 1.56 [CI, 1.42 to 1.73]; negative likelihood ratio, 0.55 [CI, 0.40 to 0.76]). Six studies reported death, with a median AUC of 0.62 (range, 0.54 to 0.78). A pooled AUC for predicting death could not be calculated because of very high heterogeneity (I2Â = 95%).
Studies generally were of low methodological quality, had varied definitions of cardiac events, and were statistically and clinically heterogeneous.
The RCRI discriminated moderately well between patients at low versus high risk for cardiac events after mixed noncardiac surgery. It did not perform well at predicting cardiac events after vascular noncardiac surgery or at predicting death. High-quality research is needed in this area of perioperative medicine.
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Cardiology, Coronary Risk Factors, Prevention/Screening.
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