Preoperative Clinical Assessment Of Cardiac Risk For Patients Having Noncardiovascular Surgery

Purpose: To (1) test the ability of clinical risk predictors in ACC/AHA guidelines for perioperative cardiovascular evaluation for noncardiac surgery to stratify Chinese noncardiovascular surgical patients ; (2) compare ACC/AHA guidelines with ASA physical status sore , combination of Goldman Index and Lee Index; (3) get the dada of postoperative cardiac morbidity and mortality and risk factors of these patients.Methods:Patients who aged ≥40 years undergoing noncardiovascular surgery with any cardiovascular abnormal, cerebrovascular disease or diabetes and all who aged ≥70 years undergoing noncardiovascular surgery were included, 1248 patients were eligible in total.We collected potential clinical risk factors and ASA score of these patients and classified them into their respective group according to ACC/AHA guidelines's risk pridictor stratification,Goldman Index,Lee Index and stratify cardiac risk of surgery by ACC/AHA guidelines.Patients were followed until discharged from hospital.Cardiac events were defined as cardiac death,myocardial infarction, myocardial ischemia ,minor myocardial cell injury,ventricular disfunction and serious arrhythmia.Likelihood ratio of these assessing methods were calculated. Risk factors for adverse events were identified by univariate analysis and multivariate Logistic regression analysis.Result:Perioperative cardiac events were observed in 53 patients. There were 3 cases of myocardial infarction,one of them died.Likelihood ratio of these assessing methods were as follow: ACC/AHA no risk group(who had none of the risk factors in ACC/AHA guidelines), 0.3; high risk group,15.1. ASA grade 11,0.5; grade IV,45.3 . Goldman index grade 1,0.8; therewas no patient in Goldman index grade IV. Lee index grade 1,1.0; grade 111,2.4.Arrhythmia by history or ECG, a history of coronary artery disease, cardiomegaly on ECG and diabetes were strongly associated with adverse outcomes of the whole patients. When analyzed risk factors of 3 groups-intermediate and high risk group,low risk group, no risk group,separately,the risk factors changed.High risk surgery , arrhythmia, advanced age,ST segment changes were risk factors of the first group. Advanced age, arrhythmia, cardiomegaly on ECG were risk factors of low risk group. Sever hypertention(3 class) and emergency surgical procedure were risk factors for no risk patients.Conclusion:ACC/AHA guidelines's risk factor stratification was better than ASA score,Goldman Index and Lee Index in cardiac risk stratification,but some uncertain predictors of the guidelines were independent predictors.