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The Journal of Thoracic and Cardiovascular Surgery, Vol 100, 595-605, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
LA Michel, J Jamart, HA Bradpiece and RA Malt
To determine the preoperative variables affecting the mortality rate and
the development of severe complications in patients who have had myocardial
revascularization or a valve replacement and who then undergo a noncardiac
operation, we retrospectively studied data from 120 such patients over the
5 years from 1982 through 1986. Thirty-six percent of patients had a
noncardiac operation during the first month after the cardiac operation.
The mortality rate was 11%, and the morbidity rate was 56%. The statistical
comparison of the predictive accuracy of postoperative complications of
three simple, widely used classifications (American Society of
Anesthesiologists physical status, New York Heart Association
classification, Massachusetts General Hospital cardiac risk index)
demonstrated the superiority of the simplified three-class cardiac risk
index (Massachusetts General Hospital-cardiac risk index; predictive
accuracy of 84%). In a multivariate discriminant analysis of 21 variables
in this population, five variables (myocardial infarction in previous 6
months, S3 gallop or jugular vein distention, arrhythmia on last
preoperative electrocardiogram, emergency operation, delay between cardiac
and noncardiac operation) were identified as being the most predictive of a
postoperative complication. When these variables were used in the function
(DF3) obtained by linear discriminant analysis, the prediction accuracy of
a postoperative complication reached 83%. Performance of the new models in
a prospective validation population remained satisfactory (75% for
Massachusetts General Hospital-cardiac risk index three-class index and 72%
for DF3). Extensive statistical analysis of our data tested by a validation
study provided simple predictive models based on clinical variables easily
available even in emergency situations.
ARTICLES
Prediction of risk in noncardiac operations after cardiac operations
Surgical Service, University of Louvain, Academic Hospital, Mont- Godinne, Yyoir, Belgium.
This article has been cited by other articles:
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  L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery J. Am. Coll. Cardiol., October 23, 2007; 50(17): e159 - e242. [Full Text] [PDF]
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 L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Circulation, October 23, 2007; 116(17): e418 - e500. [Full Text] [PDF]
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 L A Michel and P Johnson Is surgical mystique a myth and double standard the reality? Med. Humanit., December 1, 2002; 28(2): 66 - 70. [Abstract] [Full Text] [PDF]
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K. A. Eagle, P. B. Berger, H. Calkins, B. R. Chaitman, G. A. Ewy, K. E. Fleischmann, L. A. Fleisher, J. B. Froehlich, R. J. Gusberg, J. A. Leppo, et al. ACC/AHA Guideline Update for Perioperative Cardiovascular Evaluation for Noncardiac Surgery--Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Circulation, March 12, 2002; 105(10): 1257 - 1267. [Full Text] [PDF]
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K. A. Eagle, P. B. Berger, H. Calkins, B. R. Chaitman, G. A. Ewy, K. E. Fleischmann, L. A. Fleisher, J. B. Froehlich, R. J. Gusberg, J. A. Leppo, et al. ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery--executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) J. Am. Coll. Cardiol., February 6, 2002; 39(3): 542 - 553. [Full Text] [PDF]
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L. A. Michel, A. Rosiere, T. H. Lee, E. R. Marcantonio, C. M. Mangione, E. J. Thomas, C. A. Polanczyk, E. F. Cook, D. J. Sugarbaker, M. C. Donaldson, et al. Simple Index for Prediction of Cardiac Risk in Stable Patients Undergoing Nonurgent Major Noncardiac Surgery: What About the More Severely Compromised Patients? Response Circulation, October 10, 2000; 102 (15): e106 - e106. [Full Text] [PDF]
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 K. Gilbert, B. J. Larocque, and L. T. Patrick Prospective Evaluation of Cardiac Risk Indices for Patients Undergoing Noncardiac Surgery Ann Intern Med, September 5, 2000; 133(5): 356 - 359. [Abstract] [Full Text] [PDF]
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 M. J. Ali, P. Davison, W. Pickett, and N. S. Ali ACC/AHA guidelines as predictors of postoperative cardiac outcomes Can J Anesth, January 1, 2000; 47(1): 10 - 19. [Abstract] [Full Text] [PDF]
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 L. Goldman A 75-Year-Old Woman With an Abdominal Aortic Aneurysm and Emphysema JAMA, July 22, 1998; 280(4): 366 - 372. [Full Text] [PDF]
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 D. T. Mangano and L. Goldman Preoperative Assessment of Patients with Known or Suspected Coronary Disease N. Engl. J. Med., December 28, 1995; 333(26): 1750 - 1756. [Full Text] [PDF]
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L. Goldman Assessment of Perioperative Cardiac Risk N. Engl. J. Med., March 10, 1994; 330(10): 707 - 709. [Full Text]
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