Canadian Journal of Anesthesia

, Volume 47, Issue 1, pp 10–19

ACC/AHA guidelines as predictors of postoperative cardiac outcomes

  • Mohamed J. Ali
  • Patrick Davison
  • William Pickett
  • Naheed S. Ali
Reports of Investigation

Abstract

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 IV angina, and M1 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.

Résumé

Objectif

Récemment, I American College of Cardiology—American Heart Association (ACC-AHA) a publié des recommandations, et un algorithme qui leur est associé, pour l’évaluation cardiovasculaire préopératoire des patients qui doivent subir une intervention chirurgicale non cardiaque. Notre objectif était de (i) tester la capacité des recommandations à prédire les complications cardiaques qui pourraient se produire dans les sept jours suivant l’opération, (ii) déterminer si ce sont les facteurs prédictifs médicaux cliniques ou les risques chirurgicaux qui peuvent le mieux prédire les complications cardiaques.

Méthode

On a procédé à une revue rétrospective de 119 consultations en cardiologie et en anesthésie des 15 mois précédant le 31 mars 1998. Les patients ont été répartis en divers groupes selon leur facteur prédictif médical clinique respectif et les risques chirurgicaux liés à leur condition, comme l’indiquent les recommandation ACC-AHA. Les associations entre les facteurs prédictifs médicaux et les scores de risques chirurgicaux et les complications cardiaques ont été quantifiées au moyen d’une analyse de régression logistique multifactorielle. Deux complications ont servi à l’analyse. La complication I comprenait l’infarctus du myocarde (IM)/I’ischémie, l’angine, l’insuffisance cardiaque congestive, l’arythmie ou la mort. La complication 2 étendait la définition pour inclure, dans les complications cardiaques, «l’annulation de l’opération à cause des risques cardiaques».

Resultats

Le diabète, l’angine des classes III et IV de la Société Cardiovasculaire Canadienne (SCC) et l’IM se produisant pendant les six mois qui précèdent l’opération ont été étroitement associés aux deux complications cardiaques. Dans le cas des complications 1 et 2, les facteurs prédictifs médicaux et les risques chirurgicaux, considérés simultanément, ont montré une sensibilité de 93 % et une spécificité de 46–51 %. Considérés séparément, les facteurs prédictifs médicaux cliniques les plus importants ont présenté une sensibilité de 87–89 % tandis que les risques chirurgicaux ont montré une spécificité de 89 % en prédisant les deux complications.

Conclusion

Les facteurs prédictifs médicaux de la classification ACC-AHA ont été très sensibles alors que les risques chirurgicaux ont été plus spécifiques en prédisant des complications cardiaques postopératoires. Une étude prospective demeure nécessaire pour confirmer ces observations.

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Copyright information

© Canadian Anesthesiologists 2000

Authors and Affiliations

  • Mohamed J. Ali
    • 1
  • Patrick Davison
    • 2
  • William Pickett
    • 3
  • Naheed S. Ali
    • 4
  1. 1.Department of AnaesthesiaQueens UniversityCanada
  2. 2.Department of SurgeryQueens UniversityCanada
  3. 3.Department of Community Health and EpidemiologyQueens UniversityCanada
  4. 4.Department of Medicine (Division of Cardiology)Queens UniversityCanada
  5. 5.Department of AnesthesiaThe Toronto HospitalTorontoCanada

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