This Article Résumé de cet Article Full Text Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ali, M. J. Articles by Ali, N. S. Search for Related Content PubMed PubMed Citation Articles by Ali, M. J. Articles by Ali, N. S. Related Collections General Anesthesia

ACC/AHA guidelines as predictors of postoperative cardiac outcomes

Mohamed J. Ali, MD FRCPC^*, Patrick Davison, MD, William Pickett, PhD and Naheed S. Ali, MD FRCPC

^* From the Departments of Anaesthesia,
Surgery,
Community Health and Epidemiology, and
Medicine (Division of Cardiology), Queens University, 76 Stuart St., K7L 2V7 Canada.

Address correspondence to: Dr. M.J. Ali, Department of Anesthesia, The Toronto Hospital, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4 Canada. Phone: 416-340-3242; Fax: 416-340-3698; E-mail: mja{at}post.queensu.ca

Purpose: Recently, the American College of Cardiology - American Heart Association (ACC-AHA) published guidelines and an associated algorithm for preoperative cardiovascular evaluation of patients undergoing non-cardiac surgery. Our purpose was to (i) test guideline's ability to predict adverse cardiac events within seven days after surgery, (ii) determine whether medical clinical predictors or surgical risks was a better predictor of cardiac events.

Methods: Retrospective review of 119 cardiology and anesthesia consultations over 15 mo, ending March 31, 1998. Patients were classified into their respective medical clinical predictor and surgical risk groups, as outlined in ACC-AHA guidelines. Associations between the medical predictor and surgical risk scores and adverse cardiac outcomes were quantified via multiple logistic regression analysis. Two outcomes were employed. Outcome 1, included: myocardial infarction/ischemia; angina; congestive heart failure, arrhythmia or death. Outcome 2 expanded the definition to include "cancellation of surgery due to cardiac risk" as a negative cardiac outcome.

Results: Diabetes, Canadian Cardiovascular Class (CCS) 111 or 1V angina, and MI within six months before surgery were strongly associated with the two cardiac outcomes. For outcome 1 and 2, medical predictors and surgical risks, considered simultaneously, performed with a sensitivity of 93% and specificity of 46-51%. When considered separately, major clinical medical predictors had a sensitivity of 87-89%, while surgical risks showed a specificity of 89% in predicting the two outcomes.

Conclusion: Medical predictors in ACC-AHA classification scheme were highly sensitive whereas surgical risks were more specific in predicting adverse post-operative cardiac events. Prospective study is needed to confirm these observations.

This article has been cited by other articles:

				A. B. Juul, J. Wetterslev, C. Gluud, A. Kofoed-Enevoldsen, G. Jensen, T. Callesen, P. Norgaard, K. Fruergaard, M. Bestle, R. Vedelsdal, et al. Effect of perioperative beta blockade in patients with diabetes undergoing major non-cardiac surgery: randomised placebo controlled, blinded multicentre trial. BMJ, June 24, 2006; 332(7556): 1482 - 1482. [Abstract] [Full Text] [PDF]

				L. V. Doering, A. W. McGuire, and D. Rourke Recovering From Cardiac Surgery: What Patients Want You To Know Am. J. Crit. Care., July 1, 2002; 11(4): 333 - 343. [Abstract] [Full Text] [PDF]

				J. P Reginelli and R. M Mills Non-cardiac surgery in the heart failure patient Heart, May 1, 2001; 85(5): 505 - 507. [Full Text]