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Roshanov PS, Sessler DI, Chow CK, et al. Predicting Myocardial Injury and Other Cardiac Complications After Elective Noncardiac Surgery with the Revised Cardiac Risk Index: The VISION Study. Can J Cardiol. 2021;37(8):1215-1224doi: 10.1016/j.cjca.2021.03.015.
Roshanov, P. S., Sessler, D. I., Chow, C. K., Garg, A. X., Walsh, M. W., Lam, N. N., Hildebrand, A. M., Biccard, B. M., Acedillo, R. R., MacNeil, S. D., Lee, V. W., Szczeklik, W., Mrkobrada, M., Thabane, L., & Devereaux, P. J. (2021). Predicting Myocardial Injury and Other Cardiac Complications After Elective Noncardiac Surgery with the Revised Cardiac Risk Index: The VISION Study. The Canadian journal of cardiology, 37(8), 1215-1224. https://doi.org/10.1016/j.cjca.2021.03.015
Roshanov, Pavel S, et al. "Predicting Myocardial Injury and Other Cardiac Complications After Elective Noncardiac Surgery with the Revised Cardiac Risk Index: The VISION Study." The Canadian journal of cardiology vol. 37,8 (2021): 1215-1224. doi: https://doi.org/10.1016/j.cjca.2021.03.015
Roshanov PS, Sessler DI, Chow CK, Garg AX, Walsh MW, Lam NN, Hildebrand AM, Biccard BM, Acedillo RR, MacNeil SD, Lee VW, Szczeklik W, Mrkobrada M, Thabane L, Devereaux PJ. Predicting Myocardial Injury and Other Cardiac Complications After Elective Noncardiac Surgery with the Revised Cardiac Risk Index: The VISION Study. Can J Cardiol. 2021 Aug;37(8):1215-1224. doi: 10.1016/j.cjca.2021.03.015. Epub 2021 Mar 23. PMID: 33766613.
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Can J Cardiol. 2021 Aug;37(8):1215-1224. doi: 10.1016/j.cjca.2021.03.015. Epub 2021 Mar 23.

Predicting Myocardial Injury and Other Cardiac Complications After Elective Noncardiac Surgery with the Revised Cardiac Risk Index: The VISION Study.

The Canadian journal of cardiology

Pavel S Roshanov, Daniel I Sessler, Clara K Chow, Amit X Garg, Michael W Walsh, Ngan N Lam, Ainslie M Hildebrand, Bruce M Biccard, Rey R Acedillo, S Danielle MacNeil, Vincent W Lee, Wojciech Szczeklik, Marko Mrkobrada, Lehana Thabane, P J Devereaux

Affiliations

  1. Division of Nephrology, London Health Sciences Centre, London, Ontario, Canada. Electronic address: [email protected].
  2. Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, United States.
  3. Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.
  4. Division of Nephrology, London Health Sciences Centre, London, Ontario, Canada.
  5. Population Health Research Institute, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
  6. Division of Nephrology, University of Calgary, Calgary, Alberta, Canada.
  7. Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada.
  8. Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Groote Schuur Hospital, Observatory, Cape Town, Western Cape, South Africa.
  9. Department of Nephrology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada.
  10. Department of Otolaryngology Head and Neck Surgery, Western University, London, Ontario, Canada; Department of Oncology, Western University, London, Ontario, Canada.
  11. Department of Renal Medicine, Westmead Hospital, Sydney, New South Wales, Australia.
  12. Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland.
  13. Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.
  14. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.

PMID: 33766613 DOI: 10.1016/j.cjca.2021.03.015

Abstract

BACKGROUND: The Revised Cardiac Risk Index (RCRI) is widely used to estimate risk of cardiac complications after noncardiac surgery; its estimates do not capture myocardial injury after noncardiac surgery (MINS). We evaluated the incidence of cardiac complications including MINS across RCRI risk classes and the RCRI's ability to discriminate, before surgery, between patients who will experience these complications and those who will not.

METHODS: This was a secondary analysis of a prospective cohort study of 35,815 patients ≥ 45 years old who had elective inpatient noncardiac surgery from 2007 to 2013 at 28 centres in 14 countries. The primary outcome was a composite of MINS, myocardial infarction, nonfatal cardiac arrest, or cardiac death within 30 days after surgery. The secondary outcome was this composite without MINS.

RESULTS: The primary outcome occurred in 4725 patients (13.2%); its incidences across RCRI classes I (no risk factors), II (1 risk factor), III (2 risk factors), and IV (≥ 3 risk factors) were, respectively, 8.2%, 15.4%, 26.6%, and 40.2% (C-statistic for discrimination 0.65 [95% confidence interval 0.62-0.68]). The secondary outcome occurred in 1174 patients (3.3%) with incidences of 1.6%, 4.0%, 7.9%, and 12.9%, respectively (C-statistic 0.69 [0.65-0.72]). Thirty-five percent of primary outcome events and 26.9% of secondary outcome events occurred in patients with no RCRI risk factors.

CONCLUSION: The RCRI alone is not sufficient to guide postoperative cardiac monitoring because 1 in 12 patients ≥ 45 years of age without any RCRI risk factors have a cardiac complication after major noncardiac surgery, and most of them would be missed without systematic troponin testing.

Copyright © 2021 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

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