Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China.
Clin Interv Aging. 2017 Dec 22;13:35-41. doi: 10.2147/CIA.S144832. eCollection 2018.
The revised Cardiac Risk Index (RCRI) is the most widely used risk prediction tool for postoperative cardiac adverse events. We aim to explore the predictive ability of the RCRI in older Chinese patients with coronary artery disease (CAD) undergoing noncardiac surgery, which has not been previously evaluated.
We performed a multicenter, prospective study. We enrolled a total of 1,202 patients, aged >60 years, with a history of CAD who underwent noncardiac surgery. Perioperative data were extracted from an electronic database. The primary end point was defined as an occurrence of a postoperative major cardiac event (PoMCE) within 30 days. Logistic regression analysis was performed to evaluate the performance of the RCRI. A modified RCRI was created and compared with the original RCRI with regard to its ability to predict postoperative cardiac events.
Of the enrolled patients, 4.3% experienced PoMCE. Most components of the RCRI were not predictive of postoperative cardiac events with the exception of insulin-dependent diabetes mellitus (odds ratio =2.38, 95% CI: 1.11-5.11; =0.03). The RCRI performed no better than chance (area under the curve =0.53; 95% CI: 0.45-0.61) in identifying patients' cardiac risk. The modified score had a higher discriminatory ability toward PoMCE (c index, 0.69 versus 0.53; <0.01).
The original RCRI shows poor predictive ability in Chinese patients with CAD undergoing noncardiac surgery.
修订后的心脏风险指数（RCRI）是术后心脏不良事件最广泛使用的风险预测工具。我们旨在探讨 RCRI 在接受非心脏手术的老年冠心病（CAD）患者中的预测能力，这在以前尚未得到评估。
我们进行了一项多中心前瞻性研究。共纳入 1202 名年龄>60 岁、有 CAD 病史的患者，这些患者接受了非心脏手术。围手术期数据从电子数据库中提取。主要终点定义为术后 30 天内发生重大心脏事件（PoMCE）。采用 logistic 回归分析评估 RCRI 的性能。创建了一个改良的 RCRI，并与原始 RCRI 进行比较，以评估其预测术后心脏事件的能力。
在纳入的患者中，有 4.3%发生了 PoMCE。除胰岛素依赖型糖尿病（比值比=2.38，95%CI：1.11-5.11；=0.03）外，RCRI 的大多数成分均不能预测术后心脏事件。RCRI 在识别患者的心脏风险方面表现不如机会（曲线下面积=0.53；95%CI：0.45-0.61）。改良评分对 PoMCE 具有更高的鉴别能力（c 指数，0.69 与 0.53；<0.01）。
原始的 RCRI 在接受非心脏手术的中国 CAD 患者中显示出较差的预测能力。
