Age-specific performance of the revised cardiac risk index for predicting cardiovascular risk in elective noncardiac surgery

Charlotte Andersson; Mads Wissenberg; Mads Emil Jørgensen; Mark A Hlatky; Charlotte Mérie; Per Føge Jensen; Gunnar Hilmar Gislason; Lars Køber; Christian Torp-Pedersen

doi:10.1161/circoutcomes.114.001298

Age-specific performance of the revised cardiac risk index for predicting cardiovascular risk in elective noncardiac surgery

Charlotte Andersson, Mads Wissenberg, Mads Emil Jørgensen, Mark A Hlatky, Charlotte Mérie, Per Føge Jensen, Gunnar Hilmar Gislason, Lars Køber, Christian Torp-Pedersen

Department of Clinical Medicine

21 Citations (Scopus)

Abstract

BACKGROUND: The revised cardiac risk index (RCRI) holds a central role in preoperative cardiac risk stratification in noncardiac surgery. Its performance in unselected populations, including different age groups, has, however, not been systematically investigated. We assessed the relationship of RCRI with major adverse cardiovascular events in an unselected cohort of patients undergoing elective, noncardiac surgery overall and in different age groups.

METHODS AND RESULTS: We followed up all individuals ≥ 25 years who underwent major elective noncardiac surgery in Denmark (January 1, 2005, to November 30, 2011) for the 30-day risk of major adverse cardiovascular events (ischemic stroke, myocardial infarction, or cardiovascular death). There were 742 of 357,396 (0.2%), 755 of 74.889 (1.0%), 521 of 11,921 (4%), and 257 of 3146 (8%) major adverse cardiovascular events occurring in RCRI classes I, II, III, and IV. Multivariable odds ratio estimates were as follows: ischemic heart disease 3.30 (95% confidence interval, 2.96-3.69), high-risk surgery 2.70 (2.46-2.96), congestive heart failure 2.65 (2.29-3.06), cerebrovascular disease 10.02 (9.08-11.05), insulin therapy 1.62 (1.37-1.93), and kidney disease 1.45 (1.33-1.59). Modeling RCRI classes as a continuous variable, C statistic was highest among age group 56 to 65 years (0.772) and lowest for those aged >85 years (0.683). Sensitivity of RCRI class >I (ie, having ≥ 1 risk factor) for capturing major adverse cardiovascular events was 59%, 71%, 64%, 66%, and 67% in patients aged ≤ 55, 56 to 65, 66 to 75, 76 to 85, and >85 years, respectively; the negative predictive values were >98% across all age groups.

CONCLUSIONS: In a nationwide unselected cohort, the performance of the RCRI was similar to that of the original cohort. Having ≥ 1 risk factor was of moderate sensitivity, but high negative predictive value for all ages.

Original language	English
Journal	Circulation. Cardiovascular quality and outcomes
Volume	8
Issue number	1
Pages (from-to)	103-8
Number of pages	6
ISSN	1941-7713
DOIs	https://doi.org/10.1161/circoutcomes.114.001298
Publication status	Published - Jan 2015

Keywords

Adult
Age Distribution
Age Factors
Aged
Aged, 80 and over
Brain Ischemia
Cardiovascular Diseases
Comorbidity
Decision Support Techniques
Denmark
Elective Surgical Procedures
Female
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction
Odds Ratio
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Stroke
Surgical Procedures, Operative
Time Factors
Treatment Outcome

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1161/circoutcomes.114.001298

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Andersson, C., Wissenberg, M., Jørgensen, M. E., Hlatky, M. A., Mérie, C., Jensen, P. F., Gislason, G. H., Køber, L., & Torp-Pedersen, C. (2015). Age-specific performance of the revised cardiac risk index for predicting cardiovascular risk in elective noncardiac surgery. Circulation. Cardiovascular quality and outcomes, 8(1), 103-8. https://doi.org/10.1161/circoutcomes.114.001298

Age-specific performance of the revised cardiac risk index for predicting cardiovascular risk in elective noncardiac surgery. / Andersson, Charlotte; Wissenberg, Mads; Jørgensen, Mads Emil et al.

In: Circulation. Cardiovascular quality and outcomes, Vol. 8, No. 1, 01.2015, p. 103-8.

Research output: Contribution to journal › Journal article › Research › peer-review

Andersson, C, Wissenberg, M, Jørgensen, ME, Hlatky, MA, Mérie, C, Jensen, PF, Gislason, GH , Køber, L & Torp-Pedersen, C 2015, 'Age-specific performance of the revised cardiac risk index for predicting cardiovascular risk in elective noncardiac surgery', Circulation. Cardiovascular quality and outcomes, vol. 8, no. 1, pp. 103-8. https://doi.org/10.1161/circoutcomes.114.001298

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abstract = "BACKGROUND: The revised cardiac risk index (RCRI) holds a central role in preoperative cardiac risk stratification in noncardiac surgery. Its performance in unselected populations, including different age groups, has, however, not been systematically investigated. We assessed the relationship of RCRI with major adverse cardiovascular events in an unselected cohort of patients undergoing elective, noncardiac surgery overall and in different age groups.METHODS AND RESULTS: We followed up all individuals ≥ 25 years who underwent major elective noncardiac surgery in Denmark (January 1, 2005, to November 30, 2011) for the 30-day risk of major adverse cardiovascular events (ischemic stroke, myocardial infarction, or cardiovascular death). There were 742 of 357,396 (0.2%), 755 of 74.889 (1.0%), 521 of 11,921 (4%), and 257 of 3146 (8%) major adverse cardiovascular events occurring in RCRI classes I, II, III, and IV. Multivariable odds ratio estimates were as follows: ischemic heart disease 3.30 (95% confidence interval, 2.96-3.69), high-risk surgery 2.70 (2.46-2.96), congestive heart failure 2.65 (2.29-3.06), cerebrovascular disease 10.02 (9.08-11.05), insulin therapy 1.62 (1.37-1.93), and kidney disease 1.45 (1.33-1.59). Modeling RCRI classes as a continuous variable, C statistic was highest among age group 56 to 65 years (0.772) and lowest for those aged >85 years (0.683). Sensitivity of RCRI class >I (ie, having ≥ 1 risk factor) for capturing major adverse cardiovascular events was 59%, 71%, 64%, 66%, and 67% in patients aged ≤ 55, 56 to 65, 66 to 75, 76 to 85, and >85 years, respectively; the negative predictive values were >98% across all age groups.CONCLUSIONS: In a nationwide unselected cohort, the performance of the RCRI was similar to that of the original cohort. Having ≥ 1 risk factor was of moderate sensitivity, but high negative predictive value for all ages.",

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AU - Andersson, Charlotte

AU - Wissenberg, Mads

AU - Jørgensen, Mads Emil

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AU - Mérie, Charlotte

AU - Jensen, Per Føge

AU - Gislason, Gunnar Hilmar

AU - Køber, Lars

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N2 - BACKGROUND: The revised cardiac risk index (RCRI) holds a central role in preoperative cardiac risk stratification in noncardiac surgery. Its performance in unselected populations, including different age groups, has, however, not been systematically investigated. We assessed the relationship of RCRI with major adverse cardiovascular events in an unselected cohort of patients undergoing elective, noncardiac surgery overall and in different age groups.METHODS AND RESULTS: We followed up all individuals ≥ 25 years who underwent major elective noncardiac surgery in Denmark (January 1, 2005, to November 30, 2011) for the 30-day risk of major adverse cardiovascular events (ischemic stroke, myocardial infarction, or cardiovascular death). There were 742 of 357,396 (0.2%), 755 of 74.889 (1.0%), 521 of 11,921 (4%), and 257 of 3146 (8%) major adverse cardiovascular events occurring in RCRI classes I, II, III, and IV. Multivariable odds ratio estimates were as follows: ischemic heart disease 3.30 (95% confidence interval, 2.96-3.69), high-risk surgery 2.70 (2.46-2.96), congestive heart failure 2.65 (2.29-3.06), cerebrovascular disease 10.02 (9.08-11.05), insulin therapy 1.62 (1.37-1.93), and kidney disease 1.45 (1.33-1.59). Modeling RCRI classes as a continuous variable, C statistic was highest among age group 56 to 65 years (0.772) and lowest for those aged >85 years (0.683). Sensitivity of RCRI class >I (ie, having ≥ 1 risk factor) for capturing major adverse cardiovascular events was 59%, 71%, 64%, 66%, and 67% in patients aged ≤ 55, 56 to 65, 66 to 75, 76 to 85, and >85 years, respectively; the negative predictive values were >98% across all age groups.CONCLUSIONS: In a nationwide unselected cohort, the performance of the RCRI was similar to that of the original cohort. Having ≥ 1 risk factor was of moderate sensitivity, but high negative predictive value for all ages.

AB - BACKGROUND: The revised cardiac risk index (RCRI) holds a central role in preoperative cardiac risk stratification in noncardiac surgery. Its performance in unselected populations, including different age groups, has, however, not been systematically investigated. We assessed the relationship of RCRI with major adverse cardiovascular events in an unselected cohort of patients undergoing elective, noncardiac surgery overall and in different age groups.METHODS AND RESULTS: We followed up all individuals ≥ 25 years who underwent major elective noncardiac surgery in Denmark (January 1, 2005, to November 30, 2011) for the 30-day risk of major adverse cardiovascular events (ischemic stroke, myocardial infarction, or cardiovascular death). There were 742 of 357,396 (0.2%), 755 of 74.889 (1.0%), 521 of 11,921 (4%), and 257 of 3146 (8%) major adverse cardiovascular events occurring in RCRI classes I, II, III, and IV. Multivariable odds ratio estimates were as follows: ischemic heart disease 3.30 (95% confidence interval, 2.96-3.69), high-risk surgery 2.70 (2.46-2.96), congestive heart failure 2.65 (2.29-3.06), cerebrovascular disease 10.02 (9.08-11.05), insulin therapy 1.62 (1.37-1.93), and kidney disease 1.45 (1.33-1.59). Modeling RCRI classes as a continuous variable, C statistic was highest among age group 56 to 65 years (0.772) and lowest for those aged >85 years (0.683). Sensitivity of RCRI class >I (ie, having ≥ 1 risk factor) for capturing major adverse cardiovascular events was 59%, 71%, 64%, 66%, and 67% in patients aged ≤ 55, 56 to 65, 66 to 75, 76 to 85, and >85 years, respectively; the negative predictive values were >98% across all age groups.CONCLUSIONS: In a nationwide unselected cohort, the performance of the RCRI was similar to that of the original cohort. Having ≥ 1 risk factor was of moderate sensitivity, but high negative predictive value for all ages.

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DO - 10.1161/circoutcomes.114.001298

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JO - Circulation: Cardiovascular Quality and Outcomes

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ER -

Age-specific performance of the revised cardiac risk index for predicting cardiovascular risk in elective noncardiac surgery

Abstract

Keywords

UN SDGs

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