Document Detail


Development and validation of a risk calculator for prediction of cardiac risk after surgery.
MedLine Citation:
PMID:  21730309     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Perioperative myocardial infarction or cardiac arrest is associated with significant morbidity and mortality. The Revised Cardiac Risk Index is currently the most commonly used cardiac risk stratification tool; however, it has several limitations, one of which is its relatively low discriminative ability. The objective of the present study was to develop and validate a predictive cardiac risk calculator.
METHODS AND RESULTS: Patients who underwent surgery were identified from the American College of Surgeons' 2007 National Surgical Quality Improvement Program database, a multicenter (>250 hospitals) prospective database. Of the 211 410 patients, 1371 (0.65%) developed perioperative myocardial infarction or cardiac arrest. On multivariate logistic regression analysis, 5 predictors of perioperative myocardial infarction or cardiac arrest were identified: type of surgery, dependent functional status, abnormal creatinine, American Society of Anesthesiologists' class, and increasing age. The risk model based on the 2007 data set was subsequently validated on the 2008 data set (n=257 385). The model performance was very similar between the 2007 and 2008 data sets, with C statistics (also known as area under the receiver operating characteristic curve) of 0.884 and 0.874, respectively. Application of the Revised Cardiac Risk Index to the 2008 National Surgical Quality Improvement Program data set yielded a relatively lower C statistic (0.747). The risk model was used to develop an interactive risk calculator.
CONCLUSIONS: The cardiac risk calculator provides a risk estimate of perioperative myocardial infarction or cardiac arrest and is anticipated to simplify the informed consent process. Its predictive performance surpasses that of the Revised Cardiac Risk Index.
Authors:
Prateek K Gupta; Himani Gupta; Abhishek Sundaram; Manu Kaushik; Xiang Fang; Weldon J Miller; Dennis J Esterbrooks; Claire B Hunter; Iraklis I Pipinos; Jason M Johanning; Thomas G Lynch; R Armour Forse; Syed M Mohiuddin; Aryan N Mooss
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Publication Detail:
Type:  Journal Article; Validation Studies     Date:  2011-07-05
Journal Detail:
Title:  Circulation     Volume:  124     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-07-26     Completed Date:  2011-09-26     Revised Date:  2012-03-29    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  381-7     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Creighton University, 601 N 30th St, Omaha, NE 68131, USA. prateekgupta@creighton.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Algorithms*
Female
Heart Arrest / diagnosis*,  etiology
Humans
Male
Middle Aged
Models, Cardiovascular*
Myocardial Infarction / diagnosis*,  etiology
Perioperative Period
Postoperative Complications / diagnosis*,  etiology
ROC Curve
Risk Assessment / methods
Surgical Procedures, Operative / adverse effects*
Comments/Corrections
Comment In:
Circulation. 2011 Jul 26;124(4):376-7   [PMID:  21788598 ]
Circulation. 2012 Feb 21;125(7):e385; author reply e386   [PMID:  22354985 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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