Gilbert K, Larocque B J, Patrick L T
University of Western Ontario, London, Canada.
Ann Intern Med. 2000 Sep 5;133(5):356-9. doi: 10.7326/0003-4819-133-5-200009050-00011.
Prediction of perioperative cardiac complications is important in the medical management of patients undergoing noncardiac surgery. Several indices have been developed to aid prediction, but their performance has not been systematically compared.
To compare four existing methods for predicting perioperative cardiac risk.
Prospective cohort study.
Two teaching hospitals in London, Ontario, Canada.
2,035 patients referred for medical consultation before elective or urgent noncardiac surgery.
Myocardial infarction, unstable angina, acute pulmonary edema, or death. The indices were compared by examining the areas under their respective receiver-operating characteristic (ROC) curves.
Cardiac complications occurred in 6.4% of patients. The area under the ROC curve was 0.625 (95% CI, 0.575 to 0.676) for the American Society of Anesthesiologists index, 0.642 (CI, 0.588 to 0.695) for the Goldman index, 0.601 (CI, 0.544 to 0.657) for the modified Detsky index, and 0.654 (0.601 to 0.708) for the Canadian Cardiovascular Society index. These values did not significantly differ.
Existing indices for prediction of cardiac complications perform better than chance, but no index is significantly superior. There is room for improvement in our ability to predict such complications.
围手术期心脏并发症的预测在接受非心脏手术患者的医疗管理中至关重要。已经开发了几种指标来辅助预测，但它们的性能尚未得到系统比较。
比较四种现有的围手术期心脏风险预测方法。
前瞻性队列研究。
加拿大安大略省伦敦市的两家教学医院。
2035例在择期或急诊非心脏手术前接受医学咨询的患者。
心肌梗死、不稳定型心绞痛、急性肺水肿或死亡。通过检查各自受试者工作特征（ROC）曲线下的面积来比较这些指标。
6.4%的患者发生了心脏并发症。美国麻醉医师协会指标的ROC曲线下面积为0.625（95%CI，0.575至0.676），戈德曼指标为0.642（CI，0.588至0.695），改良的德茨基指标为0.601（CI，0.544至0.657），加拿大心血管学会指标为0.654（0.601至0.708）。这些值无显著差异。
现有的心脏并发症预测指标的表现优于随机水平，但没有一个指标明显更优。我们预测此类并发症的能力仍有提升空间。
